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SYSTEMATIC REVIEW article

Front. Neurol.
Sec. Headache and Neurogenic Pain
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1453183

Efficacy and safety of onabotulinumtoxinA in the treatment of medication overuse headache: a systematic review

Provisionally accepted
Hui Lang Hui Lang 1Chen Peng Chen Peng 1Kongyuan Wu Kongyuan Wu 1Xiwen Chen Xiwen Chen 2Xin Jiang Xin Jiang 1Li He Li He 1*Ning Chen Ning Chen 1*
  • 1 West China Hospital, Sichuan University, Chengdu, China
  • 2 Second Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China

The final, formatted version of the article will be published soon.

    Medication overuse headache (MOH) is a chronic headache caused by regular overuse of medications. OnabotulinumtoxinA (BoNTA) is used for preventive treatment of MOH. However, its efficacy and safety remain controversial. Methods: Seven online databases (Cochrane Library, Embase, Medline, PubMed, China National Knowledge Infrastructure, Wanfang data, and Chinese BioMedical Literature Database) were searched for relevant articles published between January 2002 and March 2024. We included randomized controlled trials (RCTs) and cohort studies on the treatment of MOH using BoNTA versus a placebo or other active treatments.Results: We retrieved 487 articles in the database search. Of these, four eligible RCTs were identified after detailed screening. A total of 1259 patients with MOH (622 patients treated with BoNTA, 607 with placebo, and 30 with topiramate) were included in the four RCTs. We found that BoNTA significantly reduced headache frequency compared with placebo (mean difference, 1.89; 95% confidence interval (CI), 1.11-2.67; I 2 =0%; p<0.001). There was no significant difference between BoNTA and the placebo in terms of secondary outcomes, which included reductions in acute medication intake (MD, 1.30; 95% CI, -1.18-3.78; I 2 =0%; p=0.30), Migraine Disability Assessment questionnaire scores (MIDAS, MD, -4.04; 95% CI, -29.36-21.28; I 2 =0%; p=0.75), and Headache Impact Test scores (HIT-6, MD, 0.03; 95% CI, -1.77-1.83; I 2 =0%; p=0.97). BoNTA was more likely to cause adverse events (OR, 1.87; 95% CI, 1.45-2.42; I 2 =0%; p<0.001) than placebo.The results of this study show that BoNTA reduces headache frequency and is effective for the treatment of MOH. This systematic review was registered in PROSPERO (CRD42022315845).

    Keywords: Medication Overuse Headache, OnabotulinumtoxinA, Systematic review, Headache, Treatment

    Received: 22 Jun 2024; Accepted: 30 Aug 2024.

    Copyright: © 2024 Lang, Peng, Wu, Chen, Jiang, He and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Li He, West China Hospital, Sichuan University, Chengdu, China
    Ning Chen, West China Hospital, Sichuan University, Chengdu, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.