The use of onabotulinum toxin type A and other neurotoxins for the treatment of chronic migraine: An American Headache Society survey study.

PURPOSE: OnabotA is the only US Food and Drug Administration-approved neurotoxin for chronic migraine prevention; however, non-onabotA toxins may be equally effective. Few studies have explored clinician practices and patient outcomes with non-onabotA neurotoxins. Our study aimed to generate a statistical snapshot of clinician perspectives and treatment practices regarding onabotulinum toxin A (onabotA) and other neurotoxins for chronic migraine and comorbid conditions.

METHODS

A 15-question survey was distributed online to clinician members of the American Headache Society (AHS) assessing clinical practices using onabotA and non-onabotA toxins for chronic migraine and comorbid conditions, and descriptive analysis was performed.

RESULTS

168 respondents (162 from the United States and 6 from Canada) completed the survey (response rate 10.1 % [168/1665]). Of 48 respondents (28 % of total) using non-onabotA toxins for chronic migraine, 27 (16 %) used incobotulinum toxin A; 23 (14 %) used abobotulinum toxin A; and 12 (7 %) used rimabotulinum toxin B. Non-onabotA toxins were predominantly used due to administration/payor imposed issues (19/48; 40 %) and cost (18/48 [38 %]). Most clinicians using non-onabotA toxins reported similar efficacy to onabotA (32/48; 67 %), while fewer reported better efficacy (9/48 [19 %]) or worse efficacy (7/48 [15 %]) than onabotA. Many respondents (114/168 [68 %]) had used neurotoxins for chronic migraine in addition to other comorbid conditions, including temporomandibular joint disorders (95/114 [83 %]) and cervical dystonia (64/114 [56 %]).

CONCLUSION

While non-onabotA toxins are used less frequently for chronic migraine, they may have similar efficacy as onabotA and are used off-label in clinical practice due to administrative/payor issues or cost.