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

Document Type

Article

Publication Date

7-1-2025

Publication Title

Clinical neurology and neurosurgery

Keywords

Humans, Migraine Disorders, Botulinum Toxins, Type A, Neurotoxins, United States, Surveys and Questionnaires, Canada, Neuromuscular Agents, Chronic Disease, Societies, Medical, Male

Abstract

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.

Medical Subject Headings

Humans; Migraine Disorders; Botulinum Toxins, Type A; Neurotoxins; United States; Surveys and Questionnaires; Canada; Neuromuscular Agents; Chronic Disease; Societies, Medical; Male

PubMed ID

40373455

Volume

254

First Page

108960

Last Page

108960

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