To PREEMPT or Not to PREEMPT: Is There an Ideal Botulinum Toxin Injection Strategy for Migraine Prevention? (P2.213)
Abstract
Objective: To report clinical experience using botulinum toxin (btx) for chronic migraine headache prevention, using either PREEMPT or non-PREEMPT injection patterns.
Background: The Phase-III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) studies demonstrated onabotulinumtoxin A (obtxA) is effective in the preventive management of chronic migraine headaches. To date, obtxA remains the only one of four btx formulations FDA-approved for chronic migraine prevention. PREEMPT recommends 155 units of obtxA administered over 31 sites per injection cycle. San Antonio military treatment facility formularies provide the option to use other btx in migraine management, and using injection patterns other than the PREEMPT pattern, according to the injecting physician’s discretion.
Design/Methods: Case series. Electronic medical records from our clinic were reviewed from 2005-2015. Patients who have received either obtxA, incobotulinumtoxin A (ibtxA), or rimabotulinumtoxin B (rbtxB) for migraine prevention were included. Efficacy of response was graded as either ‘moderate’ (50[percnt] reduction in monthly migraine frequency +/- severity), ‘superior’ (75[percnt] reduction), or ‘ineffective’ (<25[percnt]).
Results: 168 patients with chronic migraine headaches, defined by ICHD-2 criteria, were identified. Number of btx injection cycles ranged from 1-48 (Average: 11). Only 5 patients (3[percnt]) received injections following the PREEMPT pattern. Of these, 2 (40[percnt]) noted…
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