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Published on: June 2, 2014
Scoping Review: The Effects of Interrupted Onabotulinumtoxin A Treatment for Chronic Migraine Prevention During the
Qing Zhao Ruan1, Daniel J Pak1, Amitabh Gulati2
1Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
Objective:
To systematically examine the literature on the clinical consequences of inadvertent delays in scheduled onabotulinumtoxin A (OTA) therapy for chronic migraine during the COVID-19 pandemic and assess recommendations when access to OTA is limited.
Background:
The coronavirus (COVID-19) pandemic was unprecedented in its impact on the global medical community. Most healthcare institutions in the United States (US) and the world had begun significantly limiting elective procedures, undermining management of many debilitating chronic conditions. OTA injections, were similarly involuntarily postponed, leading to significant setbacks in symptom control.
Methods:
A comprehensive literature search was conducted on databases of Medline and Embase with search timeframe defined as the point of database inception to March 1st, 2024, and the search was performed on March 2nd, 2024. The search strategy was independently formulated by two authors (QR and CR) and was reviewed and approved by all authors of the article after appropriate amendments.
Results:
A total of nine articles met the defined inclusion criteria. They collectively demonstrated marked delays in OTA treatment with decline in migraine symptom control measured in the form of migraine intensity, frequency, as well as patient satisfaction in disease management. Quality of care in the form of follow-ups also appeared compromised. Alternative strategies of telemedicine and the administration of calcitonin gene-related peptide monoclonal antibodies (CGRP mAb) were adopted in place of conventional treatment.
Conclusion:
The COVID-19 pandemic had caused marked clinical deterioration in the migraine patient populations across US, Europe, and the Middle East. Strategies employed to circumvent this limitation included the adoption of remote consultation via telemedicine as well as the use of pharmacological agents such as CGRP antagonists. In the event of a reoccurrence of a worldwide pandemic, strategies should be implemented to prevent the cessation of needed treatment for those suffering from chronic migraine.
Insights
Delays in onabotulinumtoxin A (OTA) therapy for chronic migraine during COVID-19 worsened symptoms and reduced patient satisfaction. Alternative treatments like telemedicine and CGRP mAbs were used, highlighting the need for pandemic preparedness in migraine management.
Area of Science:
- Neurology
- Pharmacology
- Public Health
Background:
- The COVID-19 pandemic significantly disrupted healthcare, leading to limitations in elective procedures and treatments.
- Onabotulinumtoxin A (OTA) therapy for chronic migraine was involuntarily postponed, causing setbacks in symptom control for many patients.
Purpose of the Study:
- To systematically review the clinical effects of delayed onabotulinumtoxin A (OTA) therapy for chronic migraine during the COVID-19 pandemic.
- To assess alternative treatment recommendations when OTA access is limited.
Main Methods:
- A comprehensive literature search was conducted on Medline and Embase databases up to March 1st, 2024.
- Nine articles meeting inclusion criteria were analyzed for clinical consequences and management strategies.
Main Results:
- Delayed OTA treatment correlated with increased migraine intensity and frequency, and decreased patient satisfaction.
- Quality of care, including follow-ups, was compromised.
- Telemedicine and calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) emerged as alternative strategies.
Conclusions:
- The COVID-19 pandemic led to significant clinical deterioration in chronic migraine patients.
- Telemedicine and CGRP antagonists were adopted as alternative management strategies.
- Future pandemic preparedness plans must ensure continuity of care for chronic migraine patients.
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