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Papers of the Week

Papers: 22 Apr 2023 - 28 Apr 2023

Psychology, Translational

Human Studies, Neurobiology, Pharmacology/Drug Development

Migraine/Headache, Psychological/Comorbidities

2023 Apr 15

Toxins (Basel)




Quantitative and Qualitative Pain Evaluation in Response to OnabotulinumtoxinA for Chronic Migraine: An Observational Real-Life Study.


Altamura C, Brunelli N, Viticchi G, Salvemini S, Cecchi G, Marcosano M, Fofi L, Silvestrini M, Vernieri F


(1) Background: Randomized controlled trials and real-life studies demonstrated the efficacy of OnabotulinumtoxinA (OBT-A) for CM prevention. However, no studies specifically addressed its effect on pain’s quantitative intensity and qualitative characteristics. (2) Methods: This is an ambispective study: a post-hoc retrospective analysis of real-life prospectively collected data from two Italian headache centers on CM patients treated with OBT-A over one year (i.e., Cy1-4). The primary endpoint was the changes in pain intensity (Numeric Rating Scale, NRS; the Present Pain Intensity (PPI) scale, the 6-point Behavioral Rating Scale (BRS-6)) and quality scale (the short-form McGill Pain Questionnaire (SF-MPQ)) scores. We also assessed the relationship between changes in intensity and quality of pain and disability scale (MIDAS; HIT-6) scores, monthly headache days (MHDs), and monthly acute medication intake (MAMI) (3) Results: We retrieved 152 cases (51.5 years SD 11.3, 80.3% females). From baseline to Cy-4, MHDs, MAMI, NRS, PPI, and BRS-6 scores decreased (consistently < 0.001). Only the throbbing ( = 0.004), splitting ( = 0.018), and sickening ( = 0.017) qualities of pain collected in the SF-MPQ were reduced. Score variations in MIDAS related to those in PPI scales ( = 0.035), in the BRS-6 ( = 0.001), and in the NRS ( = 0.003). Similarly, HIT-6 score changes related to PPI score modifications ( = 0.027), in BRS-6 ( = 0.001) and NRS ( = 0.006). Conversely, MAMI variation was not associated with qualitative or quantitative pain score modifications except BRS-6 ( = 0.018). (4) Conclusions: Our study shows that OBT-A alleviates migraine by reducing its impact on multiple aspects, such as frequency, disability, and pain intensity. The beneficial effect on pain intensity seems specific to pain characteristics related to C-fiber transmission and is associated with a reduction in migraine-related disability.