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The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

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Volume 16 Supplement 1

1st Joint ANIRCEF-SISC Congress

Open Access

P054. Chronic migraine and onabotulinumtoxinA: results from clinical practice

  • Matteo Paolucci1Email author,
  • Riccardo Altavilla1,
  • Giulia Gambale1,
  • Claudio Altamura1,
  • Giovanna Viticchi2,
  • Marco Bartolini2,
  • Mauro Silvestrini2 and
  • Fabrizio Vernieri1
The Journal of Headache and Pain201516(Suppl 1):A117

Published: 28 September 2015


MigraineChronic MigrainePain AssessmentOnabotulinumtoxinADisability Assessment


OnabotulinumtoxinA injection according to PREEMPT protocol is a second-line therapy for chronic migraine (CM)[1]. While its efficacy on frequency of headache has been demonstrated[2], our current clinical experience indicates that patients report benefits regardless of reduction of frequency of attacks, as Lipton et al previously showed[3]. The present study aimed at assessing the impact of botulin injection on intensity, quality and perception of pain in patients with CM.

Materials and methods

We enrolled 25 patients who underwent botulin injections from April 2014 to June 2015. We evaluated patients at baseline (T0, the day of the first botulin injection) and every three months, along with a new injection session. Evaluation consisted in a multiparametric self-assessment questionnaire: pain intensity through 11 point Box Scale (BS-11) and Present Pain Intensity (PPI), changes in functioning through 6-point Behavioral Rating Scale (BRS-6), quality of pain through Short-form McGill Pain Assessment Questionnaire (SF-MPQ) and disability through Migraine Disability Assessment (MIDAS) questionnaire and HIT-6.

At the present time, we have follow-up data for 57% of patients at three months (T1) and for 38% of patients at six months (T2).


We found a global reduction in the intensity of perceived pain and in restriction of activities due to headache: Wilcoxon signed-rank test showed significant reduction in median values of BS-11 at T1 (p 0.026) and T3 (p 0.017), of PPI at T1 (p 0.02) and T3 (p 0.046), of BRS-6 at T1 (p 0.008) and T3 (0.026). Analysis of SF-MPQ showed a significant reduction in median values of the descriptors “throbbing” at T1 (p 0.041), “splitting” at T1 (p 0.041) and “tiring-exhausting” at T1 (p 0.011). We did not find significant difference in MIDAS score at T1 and T3 and in frequency of headache in the past three months.


Our preliminary results show that the OnabotulinumtoxinA usefulness is primarily in improving the quality of life more than in reducing the frequency of headache.

Written informed consent to publication was obtained from the patient(s).

Authors’ Affiliations

Headache Centre, Policlinico Universitario Campus Bio-Medico, Rome, Italy
Clinica Neurologica, Università Politecnica delle Marche, Ancona, Italy


  1. Aurora SK, Dodick DW, Turkel CC, DeGryse RE, Silberstein SD, Lipton RB, Diener H-C, Brin MF, PREEMPT 1 Chronic Migraine Study Group: OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia. 2010, 30: 793-803. 10.1177/0333102410364676.View ArticlePubMedGoogle Scholar
  2. Diener H-C, Dodick DW, Aurora SK, Turkel CC, DeGryse RE, Lipton RB, Silberstein SD, Brin MF, PREEMPT 2 Chronic Migraine Study Group: OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia. 2010, 30: 804-814. 10.1177/0333102410364677.View ArticlePubMedGoogle Scholar
  3. Lipton RB, Varon SF, Grosberg B, McAllister PJ, Freitag F, Aurora SK, Dodick DW, Silberstein SD, Diener H-C, DeGryse RE, et al: OnabotulinumtoxinA improves quality of life and reduces impact of chronic migraine. Neurology. 2011, 77: 1465-1472. 10.1212/WNL.0b013e318232ab65.View ArticlePubMedGoogle Scholar


© Paolucci et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.


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