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PRESENTATION #7 Clinical Research | Pain Medicine


Roshina Khan, MD, Ochsner Clinic; Mike Pepper, MD, Ochsner Clinic; Elham Azizi, MD, Ochsner Clinic; Jose Posas, MD, Ochsner Clinic; Yashar Eshraghi, MD, Ochsner Clinic

Presenter: Darby Larson, BS
Ochsner Health System

Breakthroughs in migraine management have shown the benefit of neurotoxin onabotulinumtoxin A and, more recently, calcitonin gene-related peptide (CGRP) antibodies. Based on current literature, there is evidence that intramuscular injection of onabotulinumtoxin A or subcutaneous administration of anti-CGRP monoclonal antibody (MAB) will provide pain relief for chronic migraine headaches. The efficacy of onabotulinumtoxin A and anti-CGRP MAB have been studied separately, but there are no studies comparing them directly. This retrospective study evaluates the effectiveness of onabotulinumtoxin A versus the anti-CGRP MAB drug Erenumab for chronic migraine treatment.

We reviewed the data of 200 patients who met inclusion criteria. 100 patients had received treatment with onabotulinumtoxin A, and 100 had received anti-CGRP MAB treatment with Erenumab. We analyzed pain scores before and after initiation of either the neurotoxin or MAB therapy. Pain scores were obtained using the numerical pain rating scale (NPRS).

The mean pain score before neurotoxin treatment was 4.65, and the mean pain score after was 3.14. In comparison, the mean pain score before MAB therapy was 5.67, and the mean pain score after was 2.21. The average reduction in pain scores using the neurotoxin was 28.8% compared to 63.5% for MAB therapy. 55% of patients on MAB therapy had a reduction in pain scores greater than 50%, whereas 31% of patients on neurotoxin therapy had a reduction in pain scores greater than 50%.

Most patients in both treatment groups had reduced pain scores, so our findings support current literature that both neurotoxin and MAB therapy treat chronic migraine headaches. Furthermore, our study provides results to support the superiority of the anti-CGRP MAB drug Erenumab over onabotulinumtoxin A in terms of pain relief. This MAB therapy can be recommended to patients with chronic migraines refractory to conservative treatment and who fail to improve with neurotoxin therapy.