Department of Neurology, Klinikum Großhadern, Ludwig Maximilians University Munich, Marchioninistr. 15, 81377, Munich, Germany.
Migraine and Headache Clinic Königstein, Königstein im Taunus, Germany.
Sci Rep. 2020 Jul 9;10(1):11382. doi: 10.1038/s41598-020-68149-1.
Chronic migraine (CM) is a highly disabling primary headache. Botulinum toxin (onabotulinumtoxinA) is effective for treatment of CM, with ~ 50% of patients responding after 24 weeks. A response predictor would prevent unnecessary treatments. Inhibiting calcitonin gene related peptide (CGRP) release from trigeminal nociceptive fibres is one of the modes of acting discussed for onabotulinumtoxinA in CM. Therefore, we hypothesized that the response to triptans might predict response to onabotulinumtoxinA. Contrariwise, onabotulinumtoxinA treatment might affect triptan efficacy. 49 CM patients scheduled for their first onabotulinumtoxinA treatment were included. Before (T0) and three months after (T1) onabotulinumtoxinA treatment, patients rated triptan efficacy and indicated number of headache days/month. At T1, patients additionally rated onabotulinumtoxinA efficacy. Headache days/month were on average reduced by 7.1 ± 7.0 days from T0 to T1 (p < 0.001). Triptan efficacy ratings at T0 did not predict onabotulinumtoxinA efficacy ratings at T1 (p = 0.19) or reduction of headache days (p = 0.37). However, triptan efficacy significantly improved from T0 to T1 in onabotulinumtoxinA responders (p < 0.001) but not in non-responders (p = 1.00). Triptan efficacy did not predict response to onabotulinumtoxinA in CM. However, triptan efficacy increased after successful onabotulinumtoxinA treatment. This supports the hypothesis that efficacy of acute migraine treatment with triptans improves with effective migraine prophylaxis.
慢性偏头痛（CM）是一种高度致残的原发性头痛。肉毒毒素（onabotulinumtoxinA）对 CM 的治疗有效，约 50%的患者在 24 周后有反应。反应预测因子可避免不必要的治疗。抑制三叉神经伤害性纤维中降钙素基因相关肽（CGRP）的释放是讨论中 onabotulinumtoxinA 在 CM 中作用的模式之一。因此，我们假设曲坦类药物的反应可能预测对 onabotulinumtoxinA 的反应。相反，onabotulinumtoxinA 治疗可能会影响曲坦类药物的疗效。49 例计划首次接受 onabotulinumtoxinA 治疗的 CM 患者被纳入研究。在 onabotulinumtoxinA 治疗前（T0）和治疗后 3 个月（T1），患者评价曲坦类药物的疗效并指出每月头痛天数。在 T1，患者还评价了 onabotulinumtoxinA 的疗效。每月头痛天数从 T0 到 T1 平均减少 7.1±7.0 天（p<0.001）。T0 时的曲坦类药物疗效评分不能预测 T1 时的 onabotulinumtoxinA 疗效评分（p=0.19）或头痛天数的减少（p=0.37）。然而，在 onabotulinumtoxinA 应答者中，曲坦类药物的疗效从 T0 到 T1 显著改善（p<0.001），而在非应答者中则没有改善（p=1.00）。曲坦类药物的疗效不能预测 CM 对 onabotulinumtoxinA 的反应。然而，在成功接受 onabotulinumtoxinA 治疗后，曲坦类药物的疗效增加。这支持了这样一种假设，即曲坦类药物治疗急性偏头痛的疗效随着有效的偏头痛预防而提高。
