Sevinj Hamidova Abisalam
Grand Hospital and Stroke & Headache Centre, Azerbaijan
Title: Comparison of Onabotulinumtoxin A With Other Prophylactic Treatments (amitriptyline, topiramate and candesartan) of Chronic Migraine
Biography
Biography: Sevinj Hamidova Abisalam
Abstract
Chronic migraine (CM) is a major global health problem in need of an effective prophylactic treatment with minimal side effects. And the purpose of this study was to compare the efficacy and safety of onabotulinumtoxin A with topiramate (Topamax), amitriptyline, and candesartan (Onsart) prophylactic treatments in CM. A total of 170 subjects with CM- comprising of four groups–received: Group 1) onabotulinumtoxin A, max 200 units (U) at baseline and month 3; group 2) topiramate (Topamax), 4 weeks titration 100 mg/day; group 3) amitriptyline, 3 months titration, 25 mg/day; and group 4) candesartan (Onsart), 16 mg/day. In all the treatment groups, control groups received oral placebo or placebo saline injections. Treatment responder rates were assessed using Physical Global Assessment 9-point scale, including the change from baseline in the number of headache (HA/migraine/day per month); disability was measured using Headache Impact Test (HIT-6), and Migraine Disability Assessments. The overall study duration was about 9 months. Of the 170 patients (mean age, 34.4 +/-10.6 years; 95% female), 117 completed the study at the end of the 7 months of active treatment: Onabotulinumtoxin A, n=24, topiramate (Topamax), n=37; amitriptyline, n=30; and candesartan (Onsart), n=17. Almost all patients in all treatment groups reported moderate to marked improvements at all points. But 26% in topiramate group, 28% in amitriptyline group and 23% in candesartan group reported adverse effects that required discontinuation of treatment compared to only 3.1% of patients in the onabotulinumtoxin A group. Onabotulinumtoxin A is as effective for treatment in CM as the other migraine prophylactic drugs with much less side effects.