Erenumab and OnabotulinumtoxinA in Chronic Migraine: A Comparative Analysis

To compare response (reduction in headache frequency and differences in patient-reported outcomes) between Erenumab and OnabotulinumtoxinA from two phase-IV trials after 6 months of treatment.

A prospective cohort study included two parallel cohorts of chronic migraine patients treated with either Erenumab 140 mg/month or OnabotulinumtoxinA 195 U every 3 months. Participants had no additional preventive therapies or comorbid psychiatric or chronic pain conditions. Baseline data collected included demographics, monthly headache (MHD) and migraine days (MMD), impact scales (MIDAS, HIT-6, MSQ), and anxiety/depression scores (BAI, BDI-II). Assessments were repeated at 6 months. Baseline characteristics were balanced. Efficacy analysis (measured by reduction in MHD/MMD and impact scales) was conducted using paired t-test, and linear regression models compared treatment-related changes between groups.

A total of 114 patients were analyzed (57 per group), with no significant baseline differences. Both treatments produced significant reductions in headache frequency at 6 months (Erenumab: -7.93 MHD and -5.36 MMD, p < 0.001; OnabotA: -6.00 MHD and -4.31 MMD, p < 0.001), without statistically significant differences between therapies. Significant improvements were observed in HIT-6 and MSQ scores in both cohorts (p < 0.05). The Erenumab group showed significant reductions in MIDAS, BDI, and BAI scores (p < 0.05). Differences between treatments were significant for MIDAS improvements at three and 6 months (p < 0.05).

Erenumab and OnabotulinumtoxinA are effective preventive treatments for chronic migraine. No significant differences were found in the magnitude of headache reduction at 3 or 6 months when comparing both treatments.