Critical analysis of the use of onabotulinumtoxinA (botulinum toxin type A) in migraine.

Another attempt to establish onabotulinumtoxinA as a probable effective CDH prophylactic using a follow-the-pain approach in a dose of 105–260 U failed to reach statistical significance for the primary efficacy measure (mean change from baseline in the frequency of headache-free days in a 30 day period), although a significantly higher percentage of onabotulinumtoxinA patients had a ≥50% headache day frequency decrease from baseline per 30 day period at Day 180 (32.7% vs 15.0%, P = 0.027), the secondary efficacy measure. 60 In this study, most patients (61% of 355) reported a history of migraine.

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Freitag et al 53 also noted a positive trend when examining the effect of onabotulinumtoxinA on Migraine Disability Assessment Scores, but the differences did not meet statistical significance.

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