Headache Prophylaxis With BoNTA: Patient Characteristics

  1. Stephen D. Silberstein MD,
  2. Michael J. Marmura MD,
  3. James Shaw PhD, PharmD, MPH,
  4. Shengsheng Yu MS

Article first published online: 22 JUN 2009

DOI: 10.1111/j.1526-4610.2009.01481.x

Issue

Headache: The Journal of Head and Face Pain

Headache: The Journal of Head and Face Pain

Volume 50, Issue 1, pages 63–70, January 2010

Additional Information

How to Cite

Silberstein, S. D., Marmura, M. J., Shaw, J. and Yu, S. (2010), Headache Prophylaxis With BoNTA: Patient Characteristics. Headache: The Journal of Head and Face Pain, 50: 63–70. doi: 10.1111/j.1526-4610.2009.01481.x

Author Information

  1. From the Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA (S.D. Silberstein and M.J. Marmura); Department of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA (J. Shaw and S. Yu).

*M. Marmura, 8130 Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA.

Publication History

  1. Issue published online: 4 JAN 2010
  2. Article first published online: 22 JUN 2009
  3. Accepted for publication April 27, 2009.

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Keywords:

  • chronic daily headache;
  • chronic migraine;
  • medication overuse headache;
  • MIDAS;
  • botulinum toxin

(Headache 2010;50:63-70)

Objective.— To assess the characteristics of patients receiving botulinum toxin type A (BoNTA; BOTOX®) in the treatment of headache (HA) disorders.

Methods.— The following observational epidemiologic data and baseline patient characteristics were prospectively collected from eligible patients treated with BoNTA at 10 US HA specialty centers: demographics; HA diagnoses and characteristics (frequency, severity, and disability); prior and current HA treatments and response; clinical response to BoNTA; Migraine Disability Assessment (MIDAS) questionnaire; and adverse events. Patients maintained a daily HA diary and were evaluated at each follow-up visit.

Results.— Of 703 patients enrolled (mean age 43.1 years, 78.5% females, 95.4% white), nearly 66% had a diagnosis of chronic migraine (CM), with or without medication overuse. Approximately 75% had severe disability (MIDAS grade IV), and the mean pain rating was 6.5 (where 0 = no pain, 10 = pain as bad as it can be). More than 90% of patients had ≥1 prophylactic HA treatment failure; median number of failures was 4. Significant association was observed between HA frequency and MIDAS grade (P < .001). Approximately 80% of patients with CM had severe (grade IV) disability. The median number of monthly medication days was higher in the group with MIDAS grade IV (P < .001). HA frequency and severity, failed prophylactic therapies, and greater number of coexisting medical conditions were all negatively associated with measures of health-related quality of life.

Conclusions.— Majority of patients treated with BoNTA in a specialty HA center presented with a CM diagnosis. HA disability was correlated with measures of frequency and treatment utilization.

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