Effects of Procedural Discomfort and Expectation of Benefit on Therapy Continuation in Chronic Migraine Patients Treated With OnabotulinumtoxinA.
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.
['Anderson|Christopher C|CC|https://orcid.org/0000-0003-0660-0667', 'Ray|Christopher A|CA|https://orcid.org/0000-0001-5251-3228', 'Butler|Michael R|MR|', 'Darken|Rachel S|RS|']
D000328:Adult D019274:Botulinum Toxins, Type A D002908:Chronic Disease D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D008881:Migraine Disorders D009465:Neuromuscular Agents D000073818:Pain, Procedural D010342:Patient Acceptance of Health Care D017060:Patient Satisfaction D012189:Retrospective Studies D012737:Sex Factors
adult botulinum toxins type A chronic disease humans migraine disorders neuromuscular agents