A Propensity Score Matching Study on the Effect of OnabotulinumtoxinA Alone versus Short-Term Psychodynamic Psychotherapy Plus Drug-of-Choice as Preventive Therapy in Chronic Migraine: Effects and Predictive Factors

Michele Alessiani; Barbara Petolicchio; Rita De Sanctis; Martina Squitieri; Romina Di Giambattista; Marta Puma; Ciro Franzese; Massimiliano Toscano; Chiara-Camilla Derchi; Edmond Gilliéron; Alessandro Viganò; Vittorio Di Piero

doi:10.1159/000525152

A Propensity Score Matching Study on the Effect of OnabotulinumtoxinA Alone versus Short-Term Psychodynamic Psychotherapy Plus Drug-of-Choice as Preventive Therapy in Chronic Migraine: Effects and Predictive Factors

Eur Neurol. 2022;85(6):453-459. doi: 10.1159/000525152. Epub 2022 Jun 30.

Authors

Michele Alessiani¹, Barbara Petolicchio^{2

3}, Rita De Sanctis^{4

5}, Martina Squitieri⁶, Romina Di Giambattista⁷, Marta Puma², Ciro Franzese^{5

8}, Massimiliano Toscano^{2

9}, Chiara-Camilla Derchi¹⁰, Edmond Gilliéron⁶, Alessandro Viganò¹⁰, Vittorio Di Piero^{2

3

7}

Affiliations

¹ Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy.
² Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.
³ "Enzo Borzomati" Pain Medicine Unit, University Hospital Policlinico Umberto I, Rome, Italy.
⁴ Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Italy.
⁵ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
⁶ NEUROFARBA Department, University of Florence, Florence, Italy.
⁷ Istituto Europeo di Psicoterapia Psicoanalitica, IREP, Rome, Italy.
⁸ Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital (IRCCS), Rozzano, Italy.
⁹ Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
¹⁰ IRCSS, Fondazione Don Carlo Gnocchi, Milan, Italy.

PMID: 35772386
DOI: 10.1159/000525152

Abstract

Objective: The objective of this study was to test the superiority of multidisciplinary approach, that is, Short-Term Psychodynamic Psychotherapy (STPP) plus drug of choice, versus monotherapy, that is, OnabotulinumtoxinA (OnaBoNT-A).

Method: We consecutively recorded data from chronic migraine (CM) patients, with or without medication overuse headache (MOH), who underwent STPP or OnaBoNT-A, with a 3-month follow-up schedule. Headache days and analgesics intake were monitored as primary outcome measures. Propensity score matching (PSM) was used to eliminate discrepancies between groups. Discriminant function analysis (DFA) was used to pinpoint predictive factors associated with the clinical response.

Results: 96 patients with CM (64% with MOH) were treated with STPP and 54 (59% with MOH) with OnaBoNT-A. At baseline, OnaBoNT-A patients had more failed preventive therapies, more years of illness and chronicity, and were older; STPP patients were more depressed and had a higher HIT-6. Both STPP and OnaBoNT-A patients showed a significant reduction of headache days (STPP: -14 vs. OnaBoNT-A:-14.3) and analgesics intake (STPP: -12,3 vs. OnaBoNT-A -13.5 pills/month), respectively. MOH diminished more in STPP, adherence was higher in OnaBoNT-A. Results were confirmed after PSM balancing of the groups for those variables that resulted as different (but age).

Conclusion: OnaBoNT-A monotherapy produced similar results to psychotherapy plus medication, after correcting for baseline differences.

Keywords: Disability; Medication overuse headache; Nonpharmacological migraine treatment; OnabotulinumtoxinA.

MeSH terms

Analgesics / therapeutic use
Botulinum Toxins, Type A* / therapeutic use
Headache
Headache Disorders, Secondary* / drug therapy
Humans
Migraine Disorders* / drug therapy
Propensity Score
Psychotherapy, Psychodynamic*

Substances

onabotulinum toxin A
Botulinum Toxins, Type A
Analgesics