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Onabotulinumtoxin A effective in older patients with chronic migraine

Presented by
Dr Raffaele Ornello , University of L’Aquila, Italy
EHC 2022
In a real-world, European, multicentre study that retrospectively evaluated a large case series of elderly patients with chronic migraine, onabotulinumtoxin A (OBT-A) provided a significant benefit in the first 3 cycles of treatment. This benefit was similar to that in younger patients.

This is an important finding for a patient population that is underserved in terms of treatment options, argued Dr Raffaele Ornello (University of L’Aquila, Italy), who presented the study results [1]. Migraine in older patients, defined here as ≥65 years, is rare, and chronic migraine even rarer. Treatment is complicated by comorbidity, and viable treatment options are warranted for older patients with chronic migraine. This study evaluated OBT-A as preventative therapy in this population to see whether it is as effective as in younger chronic migraine patients (<65 years). The post-hoc analysis prospectively collected real-world data at 16 European headache centres. It studied the effects of 3 treatment cycles of OBT-A in a cohort of 2,831 patients with chronic migraine. The primary endpoint was the change in monthly headache days (MHDs) from baseline to each treatment cycle in older versus younger participants.

Of the 2,831 participants, 235 (8.3%) were older (mean age 69.6 years; range 65–91), and 73.2% were women. They had had migraine for a mean of 47.2 years, and 15.2 years of migraines with a chronic frequency. According to Dr Ornello, OBT-A was as effective in older as in younger patients. There was no significant difference in any of the efficacy outcome measures.

In the older population, the number of MHDs at baseline was 24.8. A progressive decrease in MHDs was seen from baseline to cycle 1 (17.5; P<0.000001), from cycle 1 to cycle 2 (14.8; P<0.0001), and from cycle 2 to cycle 3 (11.9; P=0.001). The same was true for the proportion of patients who conversed from chronic migraine to episodic migraine, with percentages of about 40% after cycle 1, 55% after cycle 2, and 70% after cycle 3.

The number of days with acute medication use progressively decreased from baseline (19.2) to cycle 1 (11.9; P<0.00001), from cycle 1 to cycle 2 (10.9; P=0.012), and from cycle 2 to cycle 3 (9.6; P=0.049). The 50% responder rate (RR) increased from 30.7% (cycle 1) to 34.5% (cycle 2), and 38.7% (cycle 3). Older age did not predict a lower 50% RR.


    1. Ornello R. OnabotulinumtoxinA in elderly patients with chronic migraine: insights from a Real-Life European Multicenter Study. Abstract A42, EHC 2022, 7–10 December, Vienna, Austria.


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