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Cochrane systematic review and meta-analysis of botulinum toxin for the prevention of migraine

Herd, Clare P.; Tomlinson, Claire L.; Rick, Caroline; Scotton, William J.; Edwards, Julie; Ives, Natalie J.; Clarke, Carl E.; Sinclair, A.J.

Cochrane systematic review and meta-analysis of botulinum toxin for the prevention of migraine Thumbnail


Authors

Clare P. Herd

Claire L. Tomlinson

William J. Scotton

Julie Edwards

Natalie J. Ives

Carl E. Clarke

A.J. Sinclair



Abstract

Objectives To assess the effects of botulinum toxin for prevention of migraine in adults.

Design Systematic review and meta-analysis.

Data sources CENTRAL, MEDLINE, Embase and trial registries.
Eligibility criteria We included randomised controlled trials (RCTs) of botulinum toxin compared with placebo, active treatment or clinically relevant different dose for adults with chronic or episodic migraine, with or without the additional diagnosis of medication overuse headache.

Data extraction and synthesis Cochrane methods were used to review double-blind RCTs. Twelve week post-treatment time-point data was analysed.

Results Twenty-eight trials (n=4190) were included. Trial quality was mixed. Botulinum toxin treatment resulted in reduced frequency of −2.0 migraine days/month (95% CI −2.8 to −1.1, n=1384) in chronic migraineurs compared with placebo. An improvement was seen in migraine severity, measured on a numerical rating scale 0 to 10 with 10 being maximal pain, of −2.70 cm (95% CI −3.31 to −2.09, n=75) and −4.9 cm (95% CI −6.56 to −3.24, n=32) for chronic and episodic migraine respectively. Botulinum toxin had a relative risk of treatment related adverse events twice that of placebo, but a reduced risk compared with active comparators (relative risk 0.76, 95% CI 0.59 to 0.98) and a low withdrawal rate (3%). Although individual trials reported non-inferiority to oral treatments, insufficient data were available for meta-analysis of effectiveness outcomes.

Conclusions In chronic migraine, botulinum toxin reduces migraine frequency by 2 days/month and has a favourable safety profile. Inclusion of medication overuse headache does not preclude its effectiveness. Evidence to support or refute efficacy in episodic migraine was not identified.

Citation

Herd, C. P., Tomlinson, C. L., Rick, C., Scotton, W. J., Edwards, J., Ives, N. J., …Sinclair, A. (2019). Cochrane systematic review and meta-analysis of botulinum toxin for the prevention of migraine. BMJ Open, 9(7), Article e027953. https://doi.org/10.1136/bmjopen-2018-027953

Journal Article Type Article
Acceptance Date Jun 28, 2019
Online Publication Date Jul 16, 2019
Publication Date 2019-07
Deposit Date Aug 21, 2019
Publicly Available Date Aug 21, 2019
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 9
Issue 7
Article Number e027953
DOI https://doi.org/10.1136/bmjopen-2018-027953
Public URL https://nottingham-repository.worktribe.com/output/2457027
Publisher URL https://bmjopen.bmj.com/content/9/7/e027953
Contract Date Aug 21, 2019