Impact of delaying botulinum toxin treatment in patients with migraine during the COVID-19 pandemic

Abstract

Background Due to coronavirus disease 2019 (COVID-19) pandemic response measures, the administration of botulinum toxin (BTX) was delayed for many patients during the first lockdown period in Portugal.

Objectives To review the impact of postponing BTX treatment on migraine control.

Methods This was a retrospective, single-center study. Patients with chronic migraine who had done at least three previous BTX cycles and were considered responders were included. The patients were divided into two groups, one that has had their treatment delayed (group P), and one that has not (controls). The Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol was used. Migraine-related data were obtained at baseline and at three subsequent visits.

Results The present study included two groups, group P (n = 30; 47.0 ± 14.5 years; 27 females, interval baseline -1^st visit: 5.5 [4.1–5.8] months) and the control group (n = 6; 57.7 ± 13.2 years; 6 females; interval baseline–1^st visit 3.0 [3.0–3.2] months). No difference between the groups was present at baseline. When compared to baseline, the number of days/month with migraine (5 [3–6.2] vs. 8 [6–15] p < 0.001), days using triptans/month (2.5 [0–6] vs. 3 [0–8], p = 0.027) and intensity of pain (7 [5.8–10] vs. 9 [7–10], p = 0.012) were greater in the first visit for group P, while controls did not present a significant variation. The worsening of migraine-related indicators decreased in the following visits; however, even in the third visit, it had not returned to baseline. Correlations were significant between the delayed time to treatment and the increase in days/month with migraines at the first visit after lockdown (r = 0.507; p = 0.004).

Conclusions There was a deterioration of migraine control after postponed treatments, with a direct correlation between the worsening of symptoms and the number of months that the treatment was delayed.

Resumo

Antecedentes Devido às medidas de resposta à pandemia de coronavirus disease 2019 (covid-19), a administração de toxina botulínica (TXB) foi adiada para muitos pacientes durante o primeiro confinamento em Portugal.

Objetivos Avaliar o impacto do adiamento do tratamento com TXB no controle da enxaqueca.

Métodos Estudo retrospectivo unicêntrico. Foram incluídos pacientes com enxaqueca crônica com pelo menos três ciclos prévios de TXB e que tenham sido considerados respondedores. Os pacientes foram divididos em dois grupos, sendo um com atraso do tratamento (grupo P) e outro sem atraso (controles). O protocolo Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) foi utilizado. Dados clínicos relacionados com a enxaqueca foram obtidos na consulta inicial (T0) e nas três consultas subsequentes (T1–3).

Resultados O presente estudo incluiu dois grupos, o grupo P (n = 30; 47,0 ± 14,5 anos; 27 mulheres, intervalo T0-1ª visita: 5,5 [4,1–5,8] meses) e o grupo controle (n = 6; 57,7 ± 13,2 anos; 6 mulheres; intervalo T0–1ª visita 3,0 [3,0–3,2] meses). Os grupos não apresentavam nenhuma diferença no início do estudo. Quando comparado à T0, o número de dias/mês com enxaqueca (5 [3–6,2] vs. 8 [6–15], p < 0,001), dias usando triptanos/mês (2,5 [0–6] vs. 3 [0–8], p = 0,027) e intensidade da dor (7 [5,8–10] vs. 9 [7–10], p = 0,012) foram maiores na primeira visita no grupo P, não apresentando os controles variação significativa. A piora dos indicadores relacionados com a enxaqueca diminuiu nas visitas seguintes; porém, mesmo na terceira visita, ainda não haviam retornado ao basal. As correlações foram significativas entre o atraso do tratamento e o aumento de dias/mês com enxaqueca na primeira consulta após o confinamento (r = 0,507; p = 0,004).

Conclusão Houve piora clínica da enxaqueca após o adiamento do tratamento em correlação direta com a duração do atraso.

Keywords

Migraine Disorders - Botulinum Toxins - COVID-19

Palavras-chave

Transtornos de Enxaqueca - Toxinas Botulínicas - COVID-19

Authors' Contributions

HN, GV: collected and analyzed the data, and wrote the manuscript; SD: collected and analyzed the data, and reviewed the manuscript; CC, CA: designed the study, collected the data, and reviewed the manuscript.

Publication History

Received: 03 August 2022

Accepted: 10 October 2022

Article published online:
14 April 2023

• References

• 1 Angus-Leppan H, Guiloff AE, Benson K, Guiloff RJ. Navigating migraine care through the COVID-19 pandemic: an update. J Neurol 2021; 268 (11) 4388-4395
• 2 GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018; 17 (11) 954-976
• 3 Chiang CC, Halker Singh R, Lalvani N. et al. Patient experience of telemedicine for headache care during the COVID-19 pandemic: An American Migraine Foundation survey study. Headache 2021; 61 (05) 734-739
• 4 Kristoffersen ES, Faiz KW, Sandset EC. et al. Hospital-based headache care during the Covid-19 pandemic in Denmark and Norway. J Headache Pain 2020; 21 (01) 128
• 5 Santos-Lasaosa S, Porta-Etessam J. OnabotulinumtoxinA infiltration and nerve blocks in patients with headache and neuralgia: safety recommendations to prevent SARS-CoV-2 infection. Neurologia (Engl Ed) 2020; 35 (05) 291-294 (Engl Ed)
• 6 Al-Hashel JY, Ismail II. Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a web-based survey study. J Headache Pain 2020; 21 (01) 115
• 7 Caronna E, Ballvé A, Llauradó A. et al. Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution. Cephalalgia 2020; 40 (13) 1410-1421
• 8 Rozen TD. Daily persistent headache after a viral illness during a worldwide pandemic may not be a new occurrence: Lessons from the 1890 Russian/Asiatic flu. Cephalalgia 2020; 40 (13) 1406-1409
• 9 Decreto-Lei n.° 10-A/2020,. de 13 de março, in n.° 52/2020, 1° Suplemento, Série I P.d.C.d. Ministros, Editor 2021: Diário da República. p. 2 - 13.
• 10 Tepper D. Onabotulinumtoxin [corrected] A (Botox). Headache 2014; 54 (04) 787-788
• 11 Erro R, Scannapieco S, Russo M, Picillo M, Barone P. Impact of COVID-19 on neurological patients attending a botulinum toxin service. Neurol Sci 2021; 42 (02) 433-435
• 12 Gonzalez-Martinez A, Planchuelo-Gómez Á, Guerrero ÁL. et al. Effects of the onabotulinumtoxinA follow-up delay in migraine course during the COVID-19 lockdown. Neurol Sci 2021; 42 (12) 5087-5092
• 13 Porta-Etessam J, Gonzalez-Garcia N, Matias-Guiu JA, Montero-Escribano P, Matías-Guiu J. Should We Adapt the Prescription Criteria for Specific Treatments for Migraine Due to the COVID-19 Pandemic?. Headache 2020; 60 (07) 1448-1449
• 14 Ali A. Delay in OnabotulinumtoxinA Treatment During the COVID-19 Pandemic-Perspectives from a Virus Hotspot. Headache 2020; 60 (06) 1183-1186