Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
OBJECTIVE: The objective of this selective evidence based medicine (EBM) review is to determine whether or not “Do injections of OnabotulinumtoxinA reduce migraine attack frequency in adults?”
STUDY DESIGN: A systematic review of three peer-reviewed studies published between 2015 and 2017.
DATA SOURCES: One randomized controlled trial; one randomized, double-blind, placebo-controlled clinical trial; and one observational, open-label, cohort study comparing frequency of migraine in adults when injected with OnabotulinumtoxinA (OBT-A). Based on their ability to answer the clinical question, articles were selected from PubMed and Cochrane Library.
OUTCOME(S) MEASURED: All articles were based on patient oriented outcomes and focused on mean change from baseline in number of migraine attacks per month. Self-reported questionnaires and diaries kept by patients were used to track number of attacks.
RESULTS: One study conducted (Ranoux D, Martiné G, Espagne-Dubreuilh G, et al. The journal of headache and pain. 2017;18(1): 75. doi:10.1186/s10194-017-0781-7) revealed a large treatment effect and high response rate with 41 of 63 having ≥ 50% reduction in headache days per month with OBT-A injection versus baseline (experimental event rate (EER)= 65.1%). In another study (Naderinabi B, Saberi A, Hashemi M, et al. Caspian J Intern Med. 2017; 8(3): 196-204. doi:10.22088/cjim.8.3.196) patients receiving OBT-A injections experienced a mean change from baseline of 12.4 and clinically significant improvement (P=0.0001) versus a control group of 5.2 during a three month period. In a third clinical trial (Hou M, Xie JF, Kong XP, et al. Toxins. 2015; 7(11): 4442-54. doi:10.3390/toxins7114442) patients were injected with OBT-A during a four month interval revealing a mean change in baseline of 7.2 to 3.5 headaches per month, and the study was clinically significant with a p-value of <0.01.
CONCLUSIONS: This review provides evidence from three separate studies that prophylactic injections with OBT-A greatly reduce the number of migraine attacks per month. Further research is warranted to provide more accurate time frames for efficacy and adverse effects (AE) compared to traditional prophylactic methods.
Allen, Michael, "Do Injections of Onabotulinumtoxina Reduce Migraine Attack Frequency in Adults?" (2020). PCOM Physician Assistant Studies Student Scholarship. 574.