The Use of OnabotulinumtoxinA for the Treatment of Chronic Migraine During Pregnancy: An American Headache Society Survey Study

Document Type

Conference Proceeding

Publication Date

10-16-2025

Publication Title

Cephalalgia

Abstract

Objective: The peak prevalence of migraine occurs in women of childbearing age, yet the therapeutic options for treatment of migraine during pregnancy are limited due to potential harm to the developing fetus. OnabotulinumtoxinA (onabotA) is an FDA-approved neurotoxin for treating chronic migraine. OnabotA appears safe for use in pregnancy, but a paradigm persists of provider hesitancy in using this therapy during pregnancy. Quality data evaluating the safety and efficacy of use during pregnancy is scant, however thus far has demonstrated no serious health concern. The therapeutic options for migraine during pregnancy are currently limited and few studies have been conducted to explore physicians' practices regarding the use of botulinum toxin in pregnancy. Methods: A 15-question survey exploring physicians' clinical practices using botulinum toxin injections for chronic migraine was distributed via SurveyMonkey to all members on the American Headache Society (AHS) listserv on September 21, 2021, and was closed on October 29, 2021. The final 4 questions pertained to use in pregnancy. Descriptive analysis was performed. Results: Of the 1665 members in the AHS listserv, 168 responded (162 from the United States and 6 from Canada) completed the survey (response rate 10.1% [168/1665]). • 96 (58%) reported they had not used OnabotA during pregnancy; 70 (42%) had used OnabotA during pregnancy • 97 (59%) reported continuing use of onabotA while a patient is actively trying to become pregnant; 67 (41%) reported discontinuing use of OnabotA while their patient was actively trying to become pregnant • 94 (57%) reported discontinuation of onabotA treatment when a patient became pregnant; 71 (43%) continued OnabotA treatment into pregnancy • 117 (71%) reported that they have or would consider resuming onabotA treatment during pregnancy should a patient experience refractory headache after discontinuation of the treatment; 48 (29%) reported that they still have not or would not consider restarting OnabotA treatment under those same circumstances. Conclusion: Of the providers sampled, a slight majority avoided use of onabotA during pregnancy, however would use or consider using onabotA should the patient develop refractory headache after discontinuation of onabotA due to pregnancy. Additionally, the majority of providers did not discontinue onabotA while a patient is actively trying to become pregnant.

Volume

45

First Page

333

Last Page

334

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