TY - JOUR
T1 - Effects of Procedural Discomfort and Expectation of Benefit on Therapy Continuation in Chronic Migraine Patients Treated With OnabotulinumtoxinA
AU - Anderson, Christopher C.
AU - Ray, Christopher A.
AU - Butler, Michael R.
AU - Darken, Rachel S.
N1 - Publisher Copyright:
© 2020 American Headache Society
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background: OnabotulinumtoxinA (BTX) has become a mainstream treatment for chronic migraine (CM). Patients often have varied expectations for treatment success but little is known about how these initial impressions influence continuation of therapy. Objective: To record expectations of benefit and procedural discomfort (PD) from initial BTX treatment and to investigate their association with treatment success, defined as continuation of treatment for >3 sessions within a 2-year period. Methods: A retrospective chart review of CM patients receiving initial treatment with BTX was performed. Patients were questioned about their expectations of benefit and PD as rated on a 0-10 scale. Responses were then compared with continuation of therapy beyond 3 sessions to identify the presence of significant association. Results: Responses from patients (N = 297) were analyzed. About 173 subjects continued with BTX therapy for more than 3 sessions (173/297, 58.3%). Unadjusted odds ratios (OR) for expectation of benefit (EOB) (OR 1.11, 95% CI 0.99-1.24, P =.087) and PD (OR 1.02, 95% CI 0.90-1.16, P =.780) were not significantly predictive of continuing treatment. After considering sex, age, year of treatment, and previous headache preventative trials, only female sex (OR 2.02, 95% CI 1.09-3.74, P =.025) was found to be significantly associated with treatment continuation. Conclusions: In the usual care setting, PD and EOB are not significantly associated with therapy continuation in patients receiving initial treatment with BTX for the prevention of CM. However, after considering sex, age, year of treatment, and number of previous headache preventives attempted, we found that female patients had twice the likelihood of continuing with BTX therapy compared to male patients with CM.
AB - Background: OnabotulinumtoxinA (BTX) has become a mainstream treatment for chronic migraine (CM). Patients often have varied expectations for treatment success but little is known about how these initial impressions influence continuation of therapy. Objective: To record expectations of benefit and procedural discomfort (PD) from initial BTX treatment and to investigate their association with treatment success, defined as continuation of treatment for >3 sessions within a 2-year period. Methods: A retrospective chart review of CM patients receiving initial treatment with BTX was performed. Patients were questioned about their expectations of benefit and PD as rated on a 0-10 scale. Responses were then compared with continuation of therapy beyond 3 sessions to identify the presence of significant association. Results: Responses from patients (N = 297) were analyzed. About 173 subjects continued with BTX therapy for more than 3 sessions (173/297, 58.3%). Unadjusted odds ratios (OR) for expectation of benefit (EOB) (OR 1.11, 95% CI 0.99-1.24, P =.087) and PD (OR 1.02, 95% CI 0.90-1.16, P =.780) were not significantly predictive of continuing treatment. After considering sex, age, year of treatment, and previous headache preventative trials, only female sex (OR 2.02, 95% CI 1.09-3.74, P =.025) was found to be significantly associated with treatment continuation. Conclusions: In the usual care setting, PD and EOB are not significantly associated with therapy continuation in patients receiving initial treatment with BTX for the prevention of CM. However, after considering sex, age, year of treatment, and number of previous headache preventives attempted, we found that female patients had twice the likelihood of continuing with BTX therapy compared to male patients with CM.
KW - adult
KW - botulinum toxins type A
KW - chronic disease
KW - humans
KW - migraine disorders
KW - neuromuscular agents
UR - http://www.scopus.com/inward/record.url?scp=85094862843&partnerID=8YFLogxK
U2 - 10.1111/head.14008
DO - 10.1111/head.14008
M3 - Article
C2 - 33128398
AN - SCOPUS:85094862843
SN - 0017-8748
VL - 60
SP - 2357
EP - 2363
JO - Headache
JF - Headache
IS - 10
ER -