Page 77 - The clinical aspects and management of chronic migraine Judith Anne Pijpers

Figure 3. Migraine status after 12 weeks
Withdrawal and botulinum toxin A: a double blind RCT
Proportion of participants who remained to have chronic migraine, or who transformed to episodic migraine. Episodic migraine was subcategorized in high frequent, moderate frequent and low frequent episodic migraine.
Chronic migraine: ≥ 15 headache days of which ≥ 8 migraine days; episodic migraine: not fulfilling chronic migraine criteria; episodic migraine - high frequency: > 15 headache days, but < 8 migraine days; episodic migraine - moderate frequency: 10-14 headache days; episodic migraine - low frequency: < 10 headache days
After 12 weeks, 60 patients received open-label BTA treatment (see Figure 1). Preventatives that were started as part of standard care included topiramate (23%), candesartan (11%), valproate (4%), beta-blockers (3%), amitriptyline (2%) and flunarizine (1%).
We also assessed the long term effects of withdrawal plus one or two BTA treatments versus withdrawal without BTA. There were no differences after 12, 24, 36, or 48 weeks for any of the outcome measures: days with any headache or migraine (Figure 4A and 4B), days with moderate or severe headache, cumulative number of hours with headache, or days with medication use (adjusted data not shown). These results were supported by comparisons of the unadjusted data of the four possible combinations for initial double-blind and subsequent open- label treatment which did not show any relevant difference (Table 3).
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