a Headache Science Center , National Neurological Institute C. Mondino , Pavia , Italy.
b Department of Brain and Behavioral Sciences , University of Pavia , Pavia , Italy.
Expert Rev Neurother. 2018 Feb;18(2):167-176. doi: 10.1080/14737175.2018.1419867. Epub 2017 Dec 27.
Management of chronic migraine is challenging. OnabotulinumtoxinA (OBT-A) is the only medication licensed for prevention of chronic migraine, and has been widely adopted in clinical practice. Limited data is available on its long-term use. Areas covered: Data from controlled trials are combined with available data on the long-term use of OBT-A in real-life studies, with information obtained in a recent survey among Italian headache centers, and the clinical experience of the authors. Six areas were identified as relevant to patients with chronic migraine: 1) definition of responders to OBT-A; 2) management of responders to OBT-A; 3) optimal timing of prophylaxis with OBT-A; 4) position of OBT-A in prevention of chronic migraine; 5) management of medication overuse, and 6) patient education. Expert commentary: This review provides an update on the latest evidence regarding the long-term use of OBT-A in chronic migraine and analyzes the critical issues in the decision-making process that emerge from the analysis of the literature and routine practice. A treatment algorithm is proposed for the adoption in the daily practice.
慢性偏头痛的管理具有挑战性。肉毒毒素 A （OnabotulinumtoxinA，OBT-A）是唯一被批准用于预防慢性偏头痛的药物，已在临床实践中广泛应用。关于其长期使用的数据有限。
将对照试验数据与真实研究中长期使用 OBT-A 的可用数据相结合，并结合意大利头痛中心最近的一项调查和作者的临床经验。确定了 6 个与慢性偏头痛患者相关的领域：1）对 OBT-A 有反应者的定义；2）对 OBT-A 有反应者的管理；3）OBT-A 预防的最佳时机；4）OBT-A 在预防慢性偏头痛中的地位；5）药物过度使用的管理；6）患者教育。
本综述提供了关于慢性偏头痛中 OBT-A 长期使用的最新证据更新，并分析了从文献分析和常规实践中得出的决策过程中的关键问题。提出了一个治疗算法，以供日常实践采用。
