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OnabotulinumtoxinA in elderly patients with chronic migraine: insights from a Real-Life European Multicenter Study

Raffaele Ornello
L’Aquila/ IT

Appointment

Date:
Time: –
Talk time:
Discussion time:
Location / Stream:
Strauss 1

Session

Abstracts clinical

Topics

  • Headache in the elderly
  • Migraine

Authors

claudia Altamura (Rome/ IT), Raffaele Ornello (L'Aquila/ IT), F. Ahmed (Hull/ GB), A Negro (Rome/ IT), AM Miscio (San Giovanni Rotondo (FG)/ IT), A Santoro (San Giovanni Rotondo (FG)/ IT), A Apulente (Barcelona/ ES), Antonio Russo (Naples/ IT), Marcello Silvestro (Naples/ IT), S Cevoli (Bologna/ IT), N Brunelli (Rome/ IT), C Baraldi (Modena/ IT), S Guerzoni (Modena/ IT), Anna P. Andreou (London/ GB), Giorgio Lambru (London/ GB), I Frattale (L'Aquila/ IT), K Kamm (Munich/ DE), R Ruscheweyh (Munich/ DE), M Russo (Reggio Emilia/ IT), P Torelli (Parma/ IT), E Filatova (Moscow/ RU), N Latysheva (Moscow/ RU), Anna Gryglas-Dworak (Wrocław/ PL), Marcin Straburzyński (Warsaw/ PL), C Butera (Milan/ IT), B Colombo (Milan/ IT), M Filippi (Milan/ IT), Patricia Pozo-Rosich (Barcelona/ ES), Paolo Martelletti (Rome/ IT), Simona Sacco (L'Aquila/ IT), Fabrizio Vernieri (Rome/ IT)

Abstract

Abstract text (incl. figure legends and references)

QUESTION The prevalence of migraine decreases after the fifth decade of life. However, when persisting in old age, migraine may be highly disabling, and some patients can still suffer from chronic migraine (CM). This study aimed to investigate the outcome of OBT-A as preventative therapy in elderly CM patients.

METHODS: This is a post-hoc analysis of real-life prospectively collected data at 16 European headache centers on patients treated with OBT-A for CM over the first three treatment cycles. Patients aged ≥65 years were defined as OLD, and those <65-year-old, nonOLD. The primary endpoint was the changes in monthly headache days (MHDs) from baseline to each treatment cycle (i.e., Cy1-3) in OLD compared with nonOLD participants. The secondary endpoints were the frequency of responder rate (RR) ≥50%, conversion to episodic migraine (EM) and the changes in days with acute medication use (DAMs) from baseline to Cy-3.

RESULTS In a cohort of 2831 CM patients, 235 were OLD (8.3%, range 65-91 yrs, 69.6 SD 4.7; 73.2% females) with a migraine history of 47.2 yrs (SD 13.5), of which 15.2 (SD 13.9) with a chronic frequency. After Cy-3, 32.3% of OLD participants discontinued the treatment. We observed a progressive decrease in MHDs from baseline (24.8 SD 6.2) to Cy-1 (17.5 SD 9.1, p<.000001), from Cy-1 to Cy-2 (14.8 SD 9.2, p<.0001), and from Cy-2 to Cy-3 (11.9 SD 7.9, p =.001) and in DAMs from baseline (19.2 SD 9.8) to Cy-1 (11.9 SD 8.8, p<.00001), from Cy-1 to Cy-2 (10.9 SD 8.6, p=.012), and from Cy-2 to Cy-3 (9.6 SD 7.4, p =.049). The percentage of OLD patients with RR ≥50% increased from 30.7% (Cy-1) to 34.5% (Cy-2), to 38.7% (Cy-3). The changes in MHDs and the frequency of RR ≥50% or conversion to EM did not differ in OLD compared with nonOLD patients along with the three cycles.

CONCLUSION In a population of elderly CM patients, OnabotulinumtoxinA provided a significant benefit in the first three cycles of treatment, as good as in non-old patients.