Excellent Response to OnabotulinumtoxinA: Different Definitions, Different Predictors.

Area of Science:

• Neurology
• Pharmacology

Background:

• Optimizing preventive treatments for chronic migraine is crucial.
• OnabotulinumtoxinA is a common treatment, but identifying ideal candidates is challenging.

Purpose of the Study:

• To determine the rate of excellent responders to onabotulinumtoxinA in chronic migraine patients.
• To identify predictors of excellent response to onabotulinumtoxinA.

Main Methods:

• Pooled analysis of a multicenter European study.
• Chronic migraineurs treated with onabotulinumtoxinA and followed for at least 9 months.
• Defined excellent responders by ≥75% decrease in monthly headache days or <4 monthly headache days.

Main Results:

• Approximately 10% were percent-based excellent responders and 5% were frequency-based excellent responders.
• Percent-based excellent responders showed higher medication overuse and responded earlier.
• Females were less likely to be frequency-based excellent responders.

Conclusions:

• Excellent response to onabotulinumtoxinA is achievable in a subset of chronic migraine patients.
• Medication overuse may predict better response based on headache day reduction.
• Female patients without medication overuse might experience less benefit from onabotulinumtoxinA.