OnabotulinumtoxinA Wear-off Phenomenon in the Treatment of Chronic Migraine

Alina Masters-Israilov, Matthew S. Robbins

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the frequency and features of onabotulinumtoxinA (onabotA) wear-off in chronic migraine (CM). Background: Clinical experience suggests that patients with CM frequently perceive onabotA treatment duration <12 weeks, but this phenomenon has not been well explored. Methods: This study was a retrospective chart review of patients (n = 143) with CM initiated on onabotA over a 2-year period. Wear-off was considered present with the phrase documented, a quantitative headache day increase, or increased use of abortive medications, bridging therapies or emergency department visits in the 6 weeks preceding the subsequent administration. Results: Wear-off was present in 90/143 patients (62.9%). Age, sex, medication overuse, psychiatric comorbidity, injector training level, and mean days between injections did not differ between the wear-off and no wear-off groups. Mean units injected per session in the wear-off group until first documented wear-off were significantly less vs no wear-off group (166.0 ± 13.1 vs 173.4 ± 10.3, P =.0005). Wear-off most commonly occurred 2-4 weeks before the next injection (43.3%) and after the very first injection (40.0%). Intramuscular ketorolac injections (33.3%) and peripheral nerve blocks (25.6%) were the most common bridge therapies used in the wear-off period. Conclusions: Most patients with CM receiving onabotA experience wear-off. Clinicians may consider increasing the units used from the treatment onset to reduce the frequent need for bridging therapies.

Original languageEnglish (US)
JournalHeadache
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Migraine Disorders
Injections
Ketorolac
Therapeutics
Nerve Block
Intramuscular Injections
Peripheral Nerves
Headache
Psychiatry
Hospital Emergency Service
Comorbidity
onabotulinumtoxinA

Keywords

  • migraine
  • nocebo
  • onabotulinumtoxinA
  • prevention
  • transitional therapy
  • units

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

OnabotulinumtoxinA Wear-off Phenomenon in the Treatment of Chronic Migraine. / Masters-Israilov, Alina; Robbins, Matthew S.

In: Headache, 01.01.2019.

Research output: Contribution to journalArticle

Masters-Israilov, Alina ; Robbins, Matthew S. / OnabotulinumtoxinA Wear-off Phenomenon in the Treatment of Chronic Migraine. In: Headache. 2019.
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abstract = "Objective: To evaluate the frequency and features of onabotulinumtoxinA (onabotA) wear-off in chronic migraine (CM). Background: Clinical experience suggests that patients with CM frequently perceive onabotA treatment duration <12 weeks, but this phenomenon has not been well explored. Methods: This study was a retrospective chart review of patients (n = 143) with CM initiated on onabotA over a 2-year period. Wear-off was considered present with the phrase documented, a quantitative headache day increase, or increased use of abortive medications, bridging therapies or emergency department visits in the 6 weeks preceding the subsequent administration. Results: Wear-off was present in 90/143 patients (62.9{\%}). Age, sex, medication overuse, psychiatric comorbidity, injector training level, and mean days between injections did not differ between the wear-off and no wear-off groups. Mean units injected per session in the wear-off group until first documented wear-off were significantly less vs no wear-off group (166.0 ± 13.1 vs 173.4 ± 10.3, P =.0005). Wear-off most commonly occurred 2-4 weeks before the next injection (43.3{\%}) and after the very first injection (40.0{\%}). Intramuscular ketorolac injections (33.3{\%}) and peripheral nerve blocks (25.6{\%}) were the most common bridge therapies used in the wear-off period. Conclusions: Most patients with CM receiving onabotA experience wear-off. Clinicians may consider increasing the units used from the treatment onset to reduce the frequent need for bridging therapies.",
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