Botulinum toxin type A and acute drug costs in migraine with triptan overuse.

Abstract

BACKGROUND:

Patients with chronic migraine and medication overuse are significant consumers of health care resources.

OBJECTIVE:

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

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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

• Authors: Suzanne N Christie, Rose Giammarco, Marek Gawel, Gordon Mackie, Jonathan Gladstone, Werner J Becker
• Journal: The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques (Can J Neurol Sci) Vol. 37 Issue 5 Pg. 588-94 (Sep 2010) ISSN: 0317-1671 [Print] England
• PMID: 21059503 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Neuromuscular Agents
• Tryptamines
• Botulinum Toxins, Type A

Topics

• Adolescent
• Adult
• Aged
• Analysis of Variance
• Botulinum Toxins, Type A (economics, therapeutic use)
• Disability Evaluation
• Drug Costs (statistics & numerical data)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Migraine Disorders (drug therapy, economics, prevention & control)
• Neuromuscular Agents (economics, therapeutic use)
• Surveys and Questionnaires
• Treatment Outcome
• Tryptamines (adverse effects, economics)
• Young Adult