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Botulinum toxin type A and mABs but not Topiramate (anticonvulsant) can lower the total headache days per month in case of chronic migraine with drug-induced headaches.
As per a recent systematic review published in the Cephalalgia journal, Botulinum toxin type A (BoNTA) and human monoclonal antibodies (mABs) directing calcitonin gene-related peptide (CGRP) receptors were found to be effective in decreasing the number of migraine days and had a ≥50% response rate in chronic migraine patients with medication overuse headache (MOH).
To find the effectiveness of three well-known therapies for people with CM having MOH (also called drug-induced headaches), the study researchers performed a systematic search in MEDLINE, CENTRAL, Embase and Web of Science database until May, 2022. They considered randomized controlled trials stating the outcomes of change in monthly headache or migraine days, ≥50% response rates, and change in medicine overuse status.
The Cochrane RoB2 tool was utilized to determine the risk of bias. The quality of evidence for outcomes across the included RCTs was done keeping in view the 5 features drafted in Cochrane Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Initially, 1599 records were found. Later, 10 studies met the inclusion criteria and 7 studies with relevant data were included in the meta-analysis after the screening process.
The trials assessing BoNTA comprising 1139 patients revealed a mean decrease in headache frequency by 1.92 days/month than placebo. The trials assessing mABs included 1982 patients and illustrated substantial positive effects than placebo for all the outcomes under consideration. The ≥50% response rate had an overall odds ratio of 2.90. No noteworthy difference was found in the frequency of adverse effects for both BoNTA and mABs when compared to the placebo.
There is a paucity of data concerning the effectiveness of Topiramate in these people. Other than Topiramate, BoNTA therapy led to a reduction of approximately 2 headache days per month and mABs therapy led to reduction of 2.7 migraine days/month. Uncertainties remained for BoNTA regarding the response rate. The effect size for human mABs was higher with a relatively reduced drop-out rate.
Cephalalgia
Randomized controlled studies evaluating Topiramate, Botulinum toxin type A, and mABs targeting CGRP in patients with chronic migraine and medication overuse headache: A systematic review and meta-analysis
Samita Giri et al.
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