Onabotulinumtoxin A treatment for chronic migraine improves anxiety, depression and cognitive function as well as reducing headache and migraine frequency, a West Australian study has shown.
Neurologists led by Dr Susan Ho at the St John of God Mt Lawley Hospital, Perth, conducted a study in 60 patients with chronic migraine to investigate whether the cognitive and mood complaints often reported by migraine patients are associated with the underlying pathophysiological process or related to drug treatments.
In a prospective real world study of 60 patients being treated with onabotulinumtoxinA at the neurology clinic they measured headache frequency and severity with diaries over a 12 week period. At the same time they also used computerised cognitive tests of reaction time and working memory (WM) speed and accuracy at baseline, 6 weeks and 12 weeks. Depression and anxiety levels were measured with the Patient Health Questionnaire (PHQ-9) and Penn State Worry Questionnaire-Past Week (PSWQ-PW).
The study showed that most patients had a good response to onabotulinumtoxinA, with 53 of the 60 patients (88%) achieving a 50% or greater reduction from baseline in total headache days per month at six weeks and at 12 weeks post-onabotulinumtoxinA treatment.
Compared to baseline, patients had a statistically significant reduction in mean number of headache days at six weeks (8.6 vs 24.6 days) and 12 weeks (10.6 days). Likewise, patients showed a significant reduction in mean number of migraine days at 6 weeks (2.3 days) and at 12 weeks (3.7) compared to baseline (13.0 days
In terms of cognitive function, improved scores were demonstrated for all speed outcome variables at six and 12 weeks, and for working memory and subjective cognitive performance score from baseline to 6 weeks. Patients also showed significant improvement for anxiety and depressions scores. At six weeks
However there was no overall correlation between improvements in headache and improved cognitive or mood measures.
The researchers said the good headache responses to were better than seen in some previous studies of onabotulinumtoxinA, possibly because this study had excluded patients with medication overuse headache.
They acknowledged that their small study without a control group was unable to elucidate whether the cognitive impairment seen in some migraine patients was related to headache frequency.
“[But] from a clinical perspective, it is reassuring to patients with chronic migraine that their mood and cognitive symptoms can be improved following onabotulinumtoxinA treatment and this is in addition to reduction in headache and migraine frequency,” they concluded.
The findings are published in Neurology Open.