Risk factors affecting the therapeutic effect of onabotulinum toxin a on chronic migraine
Creators: name: Mendes-Andrade, Leonor
name: Mendes–Andrade, Inês
name: Medeiros, Beatriz
name: Pinto, Madalena
name: Costa, Andreia
Publisher: name: Taylor & Francis
Year: 2025
Subjects: subject: Medicine
subject: Neuroscience
subject: Physiology
subject: FOS: Biological sciences
subject: Pharmacology
subject: Cancer
subject: Science Policy
subject: Mental Health
subject: Infectious Diseases
subject: FOS: Health sciences

description: OnabotulinumtoxinA demonstrates effectiveness in chronic migraine prevention but is hindered by variable patient responses. This study aims to identify modifiable and non-modifiable risk factors influencing the response to onabotulinumtoxinA. We conducted a retrospective cohort study at a tertiary hospital involving chronic migraine patients treated with onabotulinumtoxinA. Data on risk factors and patient perceptions were collected through medical records and questionnaires. A total of 131 patients were included. At 12 months, a significant reduction in headache frequency was observed: from 26 episodes pre-treatment to 13 at 3 months, 12 at 6 months, 11 at 9 months, and 10 at 12 months. A third of patients stopped overusing medication after treatment. Univariate logistic regressions revealed that fibromyalgia was associated with a reduced likelihood of achieving ≥50% response to onabotulinumtoxinA (OR (odds ratio) = 0.213, <i>p</i> = 0.031), while secondary education was associated with an increased likelihood of response (OR = 4.400, <i>p</i> = 0.029). Adjusted logistic regression confirmed that fibromyalgia significantly reduced the likelihood of ≥50% response (aOR (adjusted odds ratio) = 0.064, <i>p</i> = 0.033). This study confirms the real-world effectiveness of onabotulinumtoxinA in reducing headache frequency. Furthermore, patients with fibromyalgia may have a diminished likelihood of responding positively, underscoring the importance of personalized treatment strategies. Chronic migraine is a serious condition that affects daily life. People with this condition experience headaches on at least 15 days each month, with migraine symptoms on at least 8 of those days. This may significantly reduce their quality of life. OnabotulinumtoxinA is a treatment option for chronic migraine, especially for people who do not improve with other treatments. This study looked at 131 people with chronic migraine treated with OnabotulinumtoxinA at a hospital in Portugal over 12 months. The goal was to understand why some patients respond better to OnabotulinumtoxinA than others. A response was characterized by a reduction of at least 50% in the number of headache days. After one year, the number of headache days per month dropped from 26 days to 10 days on average. Many patients also stated their headaches became less intense and less frequent, and their overall quality of life improved. Unfortunately, people with fibromyalgia seemed less likely to respond well to onabotulinumtoxinA. These results show that OnabotulinumtoxinA is effective for treating chronic migraines in real-world settings. They also highlight the importance of tailoring treatments to individual patients, especially those with other health conditions.