PO-45 | Botulinum toxin in clinical practice: a turning point for chronic migraine and MOH
Chiara Zilli, Davide Chiffi, Giada Giuliani, Francesca Traccitto, Mariangela Fratino, Marta Altieri | Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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Background: Chronic migraine (CM) is a highly disabling condition with a substantial socioeconomic burden. It is often complicated by medication-overuse headache (MOH), which poses a significant therapeutic challenge. This study assessed the effectiveness of botulinum toxin in patients with CM and comorbid MOH who had received at least two treatment cycles.
Methods: A total of 48 patients (47 females, 1 male) diagnosed with CM were enrolled, including 18 with comorbid MOH. All patients received two treatment cycles of botulinum toxin following the PREEMPT injection paradigm. Among them, 29 patients had previously failed at least three prophylactic therapies. Clinical outcomes were evaluated based on changes in monthly headache days, use of acute analgesics, and scores on the HIT-6, MIDAS, and VAS scales. Pre- and post-treatment comparisons were conducted, along with subgroup analyses for patients with and without MOH.
Results: After two treatment cycles, 77% of patients showed a positive therapeutic response, defined as a ≥50% reduction in monthly headache days. On average, patients experienced a reduction of 22.5 headache days per month (Z = -5.87, p < 0.001). At baseline, patients with MOH had significantly higher monthly headache frequency and analgesic use compared to those without MOH (p = 0.0031 and p < 0.001, respectively). After treatment, these differences were no longer statistically significant, indicating a comparable therapeutic response in both groups.
Conclusion: Our real-world study supports the new IHS guidelines, suggesting that botulinum toxin should be considered a first-line treatment for patients with CM and MOH, while avoiding other ineffective prophylactic therapies. Early use may help reduce the clinical and socioeconomic burden associated with CM and MOH, improve patients’ quality of life, and minimize potential side effects.
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