San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
Center for Neurological Care and Research, San Antonio, TX, USA.
Headache. 2013 Jan;53(1):126-136. doi: 10.1111/j.1526-4610.2012.02288.x. Epub 2012 Nov 5.
To report a retrospective analysis of patients with migraine headaches treated with rimabotulinumtoxin B as preventive treatment, investigating an association between clinical responsiveness with migraine directionality and migrainous aura.
The Phase III Research Evaluating Migraine Prophylaxis Therapy studies demonstrated onabotulinumtoxin A is effective in the preventive management of chronic migraine headaches. Jakubowski et al reported greater response to onabotulinumtoxin A in migraine patients reporting inward-directed head pain (imploding or ocular) compared with outward-directed head pain (exploding), suggesting subpopulations of patients may be better candidates for its use. No correlation was found between those reporting migrainous aura and onabotulinumtoxin A responsiveness.
One hundred twenty-eight migraine patients were identified who had received rimabotulinumtoxin B injections over an average of 22 months, or 7 injection cycles. Migraine directionality was reported as inward directed (imploding, n = 72), eye centered (ocular, n = 28), outward directed (exploding, n = 16), and mixed (n = 12).
One hundred two out of one hundred twenty-eight patients (80%) improved; of these, 58 (57%) demonstrated a >75% reduction in monthly headache frequency (">75%-responders"), 76% of which noted sustained benefits >12 months with repeated injections every 10-12 weeks. Those reporting ocular- and imploding-directed headaches were significantly more likely to be >75%-responders, compared with exploding- and mixed-directed headaches (P < .0025). Patients with ocular-directed headaches were most likely to be sustained >75%-responders. Patients reporting migrainous aura were more likely to be >75%-responders (P = .0007). Those reporting exploding- and mixed-directed headaches were more likely to be nonresponders (P < .0001).
Reported migraine directionality and presence of migrainous aura predict migraine headache responsiveness to rimabotulinumtoxin B injections.
报告一项采用利鲁唑丁毒素 B 治疗偏头痛患者的回顾性分析，研究偏头痛方向与偏头痛先兆之间的临床反应相关性。
III 期研究评估偏头痛预防治疗研究表明，肉毒毒素 A 对慢性偏头痛的预防性治疗有效。Jakubowski 等人报告称，与向外偏头痛（爆炸）相比，向内偏头痛（向内塌陷或眼）患者对肉毒毒素 A 的反应更大，这表明患者的亚群可能是其更好的候选者。未发现报告偏头痛先兆与肉毒毒素 A 反应性之间存在相关性。
确定了 128 名偏头痛患者，他们在平均 22 个月或 7 个注射周期中接受了利鲁唑丁毒素 B 注射。偏头痛方向报告为向内（塌陷，n = 72），眼中心（眼，n = 28），向外（爆炸，n = 16）和混合（n = 12）。
128 例患者中有 102 例（80%）改善；其中 58 例（57%）每月头痛频率减少> 75%（“> 75%-应答者”），76%的患者注意到重复注射每 10-12 周持续 12 个月以上的益处。与爆炸和混合定向头痛相比，报告眼定向和塌陷定向头痛的患者更有可能成为> 75%-应答者（P <.0025）。报告眼定向头痛的患者最有可能成为持续> 75%-应答者。报告偏头痛先兆的患者更有可能成为> 75%-应答者（P = 0.0007）。报告爆炸和混合定向头痛的患者更可能成为无应答者（P <.0001）。
报告的偏头痛方向和偏头痛先兆的存在预测了利鲁唑丁毒素 B 注射对偏头痛头痛的反应性。
