Abstract text (incl. figure legends and references)

Question:

The onabotulinumtoxinA (onabotA) is an injectable preventive treatment of chronic migraine (CM), in 12 week"s intervals. The aim of our study was to evaluate the parient-reported outcome of off onabotA treatment and to study the influence of medication overuse.

Methods

We designed a cross-sectional study of patients with CM and at least two treatments with onabotA from August 2021 until March 2022. We proceeded to demographic and clinical characterization and evaluation of medication overuse and patient-reported outcome of onabotA response with the Patients' Global Impression of Change scale (PGICS).

Results

We included 60 patients (95,1% female) diagnosed with CM with a mean age of chronic migraine diagnosis of 31,8±14,2 years. In our cohort, 12 patients (21,8%) had evidence of current medication overuse and 25 (55,6%) had anxiety problems. On average, before onaBotA treatment patients had around 20,0 attacks per month. In 45,3% we noticed a therapeutical response after the first treatment and 86,2% showed a decrease in duration of headache attacks and a mean intensity of attacks decrease of 3 points in pain visual analog scale (VAS). The wearing-off effect was noticed in 36 patients (66,7%) before the next injection of onabotA and the majority between the 10th to 12th week post treatment. At the evaluation of PGICS, 20 patients (66,7%) reported be "better" or "much better" after onabotA treatment. There was no correlation between the presence of medication overuse and onabotA response (p=0,758) and between wearing-off and perception of onabotA therapeutical response according to PGICS (p=0,097).

Conclusion

To summarize, the presence of medication overuse does not seem to influence the onabotA response and the patient-reported outcome. Also, the wearing-off phenomena, that were noticed in the most patients, does not influence the perception of onabotA therapeutical response.