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Botulinum Toxin Type A and Acute Drug Costs in Migraine with Triptan Overuse

Published online by Cambridge University Press:  02 December 2014

Suzanne N. Christie
Department of Neurology, University of Ottawa, Ottawa
Rose Giammarco
Department of Neurology, McMaster University, Hamilton
Marek Gawel
Department of Neurology, University of Toronto, Toronto
Gordon Mackie
Department of Neurology, Richmond Hospital, Richmond, British Columbia
Jonathan Gladstone
Gladstone Headache Clinic, Toronto, Ontario
Werner J. Becker*
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Division of Neurology, Foothills Hospital, 1403 29th St NW, Calgary, Alberta, T2N 2T9, Canada.
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Patients with chronic migraine and medication overuse are significant consumers of health care resources.


To determine whether botulinum toxin type A prophylaxis reduces the cost of acute migraine medications in patients with chronic migraine and triptan overuse.


In this multicenter, open-label study, patients with chronic migraine (≥15 headache days/month) who were triptan overusers (triptan intake ≥10 days/month for ≥3 months) received botulinum toxin type A (95-130 U) at baseline and month three. Headache (HA) frequency and medication use were assessed with patient diaries, and headache-related disability by means of the MIDAS and Headache Impact Test-6 questionnaires.


Of 53 patients enrolled (mean age ± standard deviation, 46.5 years ± 8.4; 47 [88.7%] females), 48 (90.6%) completed the study at month six. Based on headache diaries, significant (P≤0.0002) decreases from baseline were observed for days per month with headache/migraine, days with any acute headache medication use, days with triptan use, and triptan doses taken per month. A significant (P<0.0001) increase from baseline in headache-free days per month was also observed. Prescription medication costs for acute headache medications decreased significantly, including significant reductions in triptan costs (mean reduction of -C$106.32 ± 122.87/month during botulinum toxin type A prophylaxis; P<0.0001). At baseline, 78% of patients had severe disability (MIDAS score) and 86.8% had severe impact due to headache (HIT-6 scores); at month six, this decreased to 60% and 68%, respectively.


Botulinum toxin type A prophylactic therapy markedly decreased costs related to acute headache medication use in patients with chronic migraine and triptan overuse.



Les patients qui souffrent de migraine chronique et qui surutilisent leur médication sont des consommateurs importants de soins de santé.


Le but de l’étude était de déterminer si la prophylaxie par la toxine botulique de type A (BoNTA) diminue le coüt de la médication utilisée pour traiter la migraine aigue chez les patients qui souffrent de migraine chronique et qui surutilisent les triptans.


Au cours de cette étude ouverte, multi¬centres, les patients atteints de migraine chronique (> 15 jours de céphalée par mois) qui surutilisaient des triptans (prise de triptans > 10 jours par mois pendant > 3 mois) ont recu de la toxine botulique de type A (95-130 U) au début de l’étude et 3 mois plus tard. La frequence des céphalées et l’utilisation de la médication ont été évaluées au moyen de carnets de migraine et l’invalidité due à la céphalée au moyen des tests de migraine MIDAS et HIT-6.


Quarante-huit (90,6%) des 53 patients admis dans l’étude ont complété cette étude de 6 mois (àge moyen 46,5 ± 8,4 ans ; 47 femmes, soit 88,7%). Selon les carnets de migraine remplis par les patients, une diminution significative (p < 0,0002) du nombre de jours par mois où la céphalée/la migraine était présente, où une médication contre la céphalée aigue a été utilisée et où un triptan a été utilisé, ainsi qu’une diminution des doses de triptan ont été observées par rapport au début de l’étude. Une augmentation significative (p < 0,0001) du nombre de jours par mois sans céphalée a également été observée. Les coüts des médicaments sous prescription pour les médicaments contre la céphalée aigue ont diminué significativement, dont une diminution significative des coüts reliés à l’utilisation des triptans (diminution moyenne de -106,32 ± 122,87 $CA/mois pendant la prophylaxie par BoNTA ; p < 0,0001). Au début de l’étude, l’invalidité était sévère chez 78% des patients (score MIDAS) et 86,8% avaient un impact sévère dü à la céphalée (score HIT-6) ; après 6 mois, les pourcentages avaient diminué à 60% et 68% respectivement.


La prophylaxie par la toxine botulique de type A diminue de facon appréciable les coüts associés à l’utilisation de la médication contre la céphalée aigue chez les patients atteints de migraine chronique qui surutilisent les triptans.

Original Article
Copyright © The Canadian Journal of Neurological 2010


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