R Ruscheweyh1, S Förderreuther2, C Gaul3, A Gendolla4, D Holle-Lee5, T Jürgens6, L Neeb7, A Straube2. 1. Neurologische Klinik und Poliklinik, Klinikum der LMU München, München, Deutschland. ruth.ruscheweyh@med.uni-muenchen.de. 2. Neurologische Klinik und Poliklinik, Klinikum der LMU München, München, Deutschland. 3. Migräne- und Kopfschmerzklinik Königstein, Königstein im Taunus, Deutschland. 4. Praxis Gendolla, Essen, Deutschland. 5. Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen, Essen, Deutschland. 6. Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Deutschland. 7. Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland.
Abstract
BACKGROUND: Injection of botulinum neurotoxin A (BoNT-A) according to the PREEMPT (Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy) paradigm has been approved for the treatment of refractory chronic migraine in Germany in 2011. OBJECTIVE: The practical application raises some questions, such as the choice of dose and injection intervals during the course of the treatment, and the appropriate time point for discontinuation of BoNT-A treatment. MATERIAL AND METHODS: Taking into account the existing literature, the German Migraine and Headache Society (Deutsche Migräne- und Kopfschmerzgesellschaft, DMKG) gives recommendations for the treatment of chronic migraine with BoNT-A. RESULTS: Treatment is usually started with a dose of 155 U BoNT-A. During the first year of treatment, 3‑month injection intervals are recommended. Goal of the treatment is an improvement of migraine by ≥30%. If needed, dose escalation up to 195 U can be used to reach this goal. If improvement by ≥30% is not reached after the third injection cycle, the treatment is usually considered to be insufficiently efficient and discontinuation is recommended. If a stable success is reached during the first year of treatment, prolongation of injection intervals to 4 months can be considered. If success continues to be stable for at least two 4‑month intervals, discontinuation of BoNT-A treatment can be tried. CONCLUSION: The literature on these points is insufficient for recommendations at the guideline level. The present recommendations are based on an expert consensus of the DMKG for the structured approach to the treatment of chronic migraine with BoNT-A.
BACKGROUND: Injection of botulinum neurotoxin A (BoNT-A) according to the PREEMPT (Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy) paradigm has been approved for the treatment of refractory chronic migraine in Germany in 2011. OBJECTIVE: The practical application raises some questions, such as the choice of dose and injection intervals during the course of the treatment, and the appropriate time point for discontinuation of BoNT-A treatment. MATERIAL AND METHODS: Taking into account the existing literature, the German Migraine and Headache Society (Deutsche Migräne- und Kopfschmerzgesellschaft, DMKG) gives recommendations for the treatment of chronic migraine with BoNT-A. RESULTS: Treatment is usually started with a dose of 155 U BoNT-A. During the first year of treatment, 3‑month injection intervals are recommended. Goal of the treatment is an improvement of migraine by ≥30%. If needed, dose escalation up to 195 U can be used to reach this goal. If improvement by ≥30% is not reached after the third injection cycle, the treatment is usually considered to be insufficiently efficient and discontinuation is recommended. If a stable success is reached during the first year of treatment, prolongation of injection intervals to 4 months can be considered. If success continues to be stable for at least two 4‑month intervals, discontinuation of BoNT-A treatment can be tried. CONCLUSION: The literature on these points is insufficient for recommendations at the guideline level. The present recommendations are based on an expert consensus of the DMKG for the structured approach to the treatment of chronic migraine with BoNT-A.
Authors: Stephen D Silberstein; Andrew M Blumenfeld; Roger K Cady; Ira M Turner; Richard B Lipton; Hans-Christoph Diener; Sheena K Aurora; Mai Sirimanne; Ronald E DeGryse; Catherine C Turkel; David W Dodick Journal: J Neurol Sci Date: 2013-06-19 Impact factor: 3.181
Authors: Stephen D Silberstein; Richard B Lipton; David W Dodick; Frederick G Freitag; Nabih Ramadan; Ninan Mathew; Jan L Brandes; Marcelo Bigal; Joel Saper; Steven Ascher; Donna M Jordan; Steven J Greenberg; Joseph Hulihan Journal: Headache Date: 2007-02 Impact factor: 5.887
Authors: A Straube; C Gaul; S Förderreuther; P Kropp; M Marziniak; S Evers; W H Jost; H Göbel; C Lampl; P S Sándor; A R Gantenbein; H-C Diener Journal: Nervenarzt Date: 2012-12 Impact factor: 1.214
Authors: Stephen D Silberstein; David W Dodick; Sheena K Aurora; Hans-Christoph Diener; Ronald E DeGryse; Richard B Lipton; Catherine C Turkel Journal: J Neurol Neurosurg Psychiatry Date: 2014-12-12 Impact factor: 10.154
Authors: Raffaele Ornello; Fayyaz Ahmed; Andrea Negro; Anna Maria Miscio; Antonio Santoro; Alicia Alpuente; Antonio Russo; Marcello Silvestro; Sabina Cevoli; Nicoletta Brunelli; Fabrizio Vernieri; Licia Grazzi; Carlo Baraldi; Simona Guerzoni; Anna P Andreou; Giorgio Lambru; Ilaria Frattale; Katharina Kamm; Ruth Ruscheweyh; Marco Russo; Paola Torelli; Elena Filatova; Nina Latysheva; Anna Gryglas-Dworak; Marcin Straburzynski; Calogera Butera; Bruno Colombo; Massimo Filippi; Patricia Pozo-Rosich; Paolo Martelletti; Simona Sacco Journal: Pain Ther Date: 2021-03-28
Authors: Lucas Hendrik Overeem; Andreas Peikert; Maxi Dana Hofacker; Katharina Kamm; Ruth Ruscheweyh; Astrid Gendolla; Bianca Raffaelli; Uwe Reuter; Lars Neeb Journal: Cephalalgia Date: 2021-10-13 Impact factor: 6.292
Authors: Bianca Raffaelli; Rea Kalantzis; Jasper Mecklenburg; Lucas Hendrik Overeem; Lars Neeb; Astrid Gendolla; Uwe Reuter Journal: Front Neurol Date: 2020-05-28 Impact factor: 4.003