Triptan efficacy does not predict onabotulinumtoxinA efficacy but improves with onabotulinumtoxinA response in chronic migraine patients

Sci Rep. 2020 Jul 9;10(1):11382. doi: 10.1038/s41598-020-68149-1.

Abstract

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.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Botulinum Toxins, Type A / pharmacology*
  • Botulinum Toxins, Type A / therapeutic use
  • Calcitonin Gene-Related Peptide / antagonists & inhibitors
  • Calcitonin Gene-Related Peptide / metabolism
  • Chronic Disease / drug therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Migraine Disorders / diagnosis
  • Migraine Disorders / drug therapy*
  • Migraine Disorders / physiopathology
  • Nociception / drug effects
  • Nociception / physiology
  • Prognosis
  • Serotonin 5-HT1 Receptor Agonists
  • Treatment Outcome
  • Trigeminal Nerve / drug effects
  • Trigeminal Nerve / metabolism
  • Tryptamines / pharmacology*
  • Tryptamines / therapeutic use

Substances

  • Serotonin 5-HT1 Receptor Agonists
  • Tryptamines
  • Botulinum Toxins, Type A
  • onabotulinum toxin A
  • Calcitonin Gene-Related Peptide