Onabotulinum May Decrease Opioid Use, Reduce Severity and Frequency of Nonmigraine Headache – Neurology Advisor

By | December 9, 2019

In patients with chronic nonmigraine headaches who have not responded to ≥2 prophylactic therapies, onabotulinum toxin type A (BoNTA) injections may effectively reduce pain severity and frequency of headaches, a study published in Frontiers in Neurology suggests.

The study was a retrospective review of 717 patients who received injections of BoNTA at a single center between 2014 and 2017. Patients had chronic nonmigraine headache type or mixed headache types that did not include migraine. Only patients who did not respond to ≥2 prophylactic therapies for headache were included in the review. The investigators compared patients’ pain severity on numeric pain scale and frequency (number of headache days/month) between baseline and 6 and 12 months.

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In both primary and secondary nonmigraine headaches, there was an overall mean reduction in headache frequency from baseline to 6 months (25.2±1.3 vs 11.9±8.4, respectively; P <.05) and 12 months (25.2±1.3 vs 7.1±1.8, respectively; P <.05). For headache pain severity, there were significant reductions from baseline to 6 months (7.0±0.4 vs 2.8±0.4, respectively; P <.05) and 12 months (7.0±0.4 vs 2.6±0.6, respectively; P <.05).

There was a significant reduction in the frequency of posttraumatic headaches from baseline to 6 and 12 months (25±1.8 vs 10.6±2.3 and 5.1±1.2, respectively; P <.05). Injections with BoNTA were also associated with notable reductions in headache days in pseudotumor cerebri from baseline to 6 and 12 months (26±2.9 vs 9.8±2.5 and 6±4, respectively; P <.05). In 5 patients who were prescribed opioids for chronic pain, the researchers found reductions in opioid use by 67±55.4 morphine equivalent units at 6 months and 133.3±106.6 morphine equivalent units at 12 months.

Limitations of the study include its retrospective nature, the lack of a standardized diagnostic method used across all patients, and the lack of a control group.

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On the basis of their findings, the researchers also noted that because each patient must have failed ≥2 “prophylactic treatments to qualify for BoNTA treatment, patients that were able to reduce their prophylaxis use during treatment suggest that BoNTA can reduce their associated side-effects.”


Jia C, Lucchese S, Zhang F, Govindarajan R. The role of onabotulinum toxin type A in the management of chronic non-migraine headaches. Front Neurol. 2019;10:1009. doi:10.3389/fneur.2019.01009

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