Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Guideline on the use of onabotulinumtoxinA in chronic migraine: a consensus statement from the European Headache Federation

Research output: Contribution to journalJournal articleResearchpeer-review

  1. PACAP38 and PAC receptor blockade: a new target for headache?

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Cilostazol induced migraine does not respond to sumatriptan in a double blind trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Fremanezumab blocks CGRP induced dilatation in human cerebral, middle meningeal and abdominal arteries

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Neck pain and headache after whiplash injury: a systematic review and meta-analysis

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Intravenous Endothelin-1 Infusion Does Not Induce Aura or Headache in Migraine Patients With Aura

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Plasma Glucose Levels Increase During Spontaneous Attacks of Migraine With and Without Aura

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Eptinezumab in episodic migraine: A randomized, double-blind, placebo-controlled study (PROMISE-1)

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Investigation of sumatriptan and ketorolac trometamol in the human experimental model of headache

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

OnabotulinumtoxinA is being increasingly used in the management of chronic migraine (CM). Treatment with onabotulinumtoxinA poses challenges compared with traditional therapy with orally administered preventatives. The European Headache Federation identified an expert group that was asked to develop the present guideline to provide recommendations for the use of onabotulinumtoxinA in CM. The expert group recommend onabotulinumtoxinA as an effective and well-tolerated treatment of CM. Patients should preferably have tried two to three other migraine prophylactics before start of onabotulinumtoxinA. Patients with medication overuse should be withdrawn from the overused medication before initiation of onabotulinumtoxinA if feasible, if not onabotulinumtoxinA can be initiated from the start or before withdrawal. OnabotulinumtoxinA should be administered according to the PREEMPT injection protocol, i.e. injecting 155 U-195 U to 31-39 sites every 12-weeks. We recommend that patients are defined as non-responders, if they have less than 30% reduction in headache days per month during treatment with onabotulinumtoxinA. However other factors such as headache intensity, disability and patient preferences should also be considered when evaluating response. Treatment should be stopped, if the patient does not respond to the first two to three treatment cycles. Response to continued treatment with onabotulinumtoxinA should be evaluated by comparing the 4 weeks before with the 4 weeks after each treatment cycle. It is recommended that treatment is stopped in patients with a reduction to less than 10 headache days per month for 3 months and that patients are re-evaluated 4-5 months after stopping onabotulinumtoxinA to make sure that the patient has not returned to CM. Questions regarding efficacy and tolerability of onabotulinumtoxinA could be answered on the basis of scientific evidence. The other recommendations were mainly based on expert opinion. Future research on the treatment of CM with onabotulinumtoxinA may further improve the management of this highly disabling disorder.

Original languageEnglish
JournalJournal of Headache and Pain
Volume19
Issue number1
Pages (from-to)91
ISSN1129-2369
DOIs
Publication statusPublished - 2018

ID: 55587974