Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, 2600, Glostrup, Denmark.
Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy.
J Headache Pain. 2018 Sep 26;19(1):91. doi: 10.1186/s10194-018-0921-8.
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 Patients with medication overuse should be withdrawn from the overused medication before initiation of onabotulinumtoxinA if feasible, if not onabotulinumtoxinA can be initiated from the start or before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.
肉毒毒素 A 越来越多地用于慢性偏头痛 (CM) 的治疗。与传统的口服预防药物相比，肉毒毒素 A 的治疗存在挑战。欧洲头痛联合会成立了一个专家组，要求其制定本指南，为肉毒毒素 A 在 CM 中的应用提供建议。专家组建议将肉毒毒素 A 作为 CM 的有效且耐受良好的治疗方法。在开始使用肉毒毒素 A 之前，患者最好已经尝试了两种或三种其他偏头痛预防药物。如果可行，应在开始肉毒毒素 A 之前停用药物过度使用的药物；如果不可行，可在开始或停用前开始肉毒毒素 A。肉毒毒素 A 应根据 PREEMPT 注射方案给药，即每 12 周在 31-39 个部位注射 155-195 U。如果患者在接受肉毒毒素 A 治疗期间每月头痛天数减少少于 30%，则建议将其定义为无应答者。然而，在评估应答时，还应考虑头痛强度、残疾和患者偏好等其他因素。如果患者在前两到三个治疗周期内没有应答，则应停止治疗。应通过比较每个治疗周期前后的 4 周来评估继续接受肉毒毒素 A 治疗的反应。建议在患者每月头痛天数减少至少于 10 天持续 3 个月时停止治疗，并在停止肉毒毒素 A 治疗后 4-5 个月重新评估患者，以确保患者未返回 CM。关于肉毒毒素 A 的疗效和耐受性的问题可以根据科学证据来回答。其他建议主要基于专家意见。关于肉毒毒素 A 治疗 CM 的未来研究可能会进一步改善这种高度致残疾病的管理。
