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Abstract Details

Role of Circadian Rhythm on the Effectiveness of Onabotulinum Toxin A (BTA) Injections as Preventive Therapy for Chronic Migraines (CM)
Headache Posters (7:00 AM-5:00 PM)
Our previous study demonstrated increased pain associated with BTA injections administered in the morning to DA patients with CM. Here we examined the effectiveness of BTA injections throughout the post-injection period of 3 months in relation to timing of BTA administration.
Evaluate the effectiveness of BTA injections in diurnally active (DA) patients with CM in relation to timing of BTA administration.
90 DA patients undergoing BTA therapy for CM prophylaxis were enrolled, then randomly assigned to morning or afternoon clinics. 155 units of BTA were administered using the standardized PREEMPT injection protocol. Patients maintained a headache diary during the post-treatment period. At the follow-up visit, number of headaches reported during the first, second, and third month following BTA injections, and number of headaches during last 7 days were recorded. Patients rated the effectiveness of BTA treatment on 1-4 effectiveness scale. Descriptive summaries included frequencies and percentages for categorical data and medians and quartiles for continuous variables. Demographic variables were tested using Chi-square and headache results were compared using the student T-test.
55 (61%) patients were injected during morning clinic and 35 (39%) during afternoon clinic. There was no significant difference in demographic variables between the groups. Average number of headaches during 3 months following BTA administration was higher for AM patients (22.37±18.85 vs. 10.54±7.5, p=0.0007). Furthermore, AM patients had a significantly higher average number of headaches during each month following injection. Number of headaches for the week prior to follow-up injections and presence of headache on the day of the follow-up was not significantly different between groups. PM patients rated BTA injections as more effective.
Afternoon BTA injections appear to improve CM prevention in DA patients with stable circadian sleep/wake routine. Physicians performing BTA injections in DA patients should consider giving injections during afternoon hours to help maximize therapeutic responsiveness.
Andres Augustus Arciniegas, MD, MSHA, MSHI
Dr. Arciniegas has nothing to disclose.
Andreja Packard, MD, PhD (Andreja Packard, MD PhD Neurology) Dr. Packard has nothing to disclose.