Gender-based Differences in Chronic Migraine Treatment Outcomes with OnabotulinumtoxinA
Avin Babakhani1, Sepideh Zandifar2
1Neurology, Semmelweis University, 2Neurology, Alborz University of Medical Sciences
Objective:
This study aims to evaluate the effectiveness of OnabotulinumtoxinA in treating chronic migraines in women and individuals assigned female at birth compared to men and individuals assigned male at birth.
Background:
Chronic migraine is a debilitating condition which disproportionately affects women and those assigned female at birth (1.7% to 4%), compared to men and those assigned male at birth (0.7%). This prevalence imbalance has limited gender-specific studies on chronic migraine treatments. Understanding these differences is crucial for patient-centric care, especially as OnabotulinumtoxinA continues to be recognized for its efficacy as a treatment option for chronic migraine.
Design/Methods:
We conducted a patient-level analysis, stratifying participants by gender, using real-life data on OnabotulinumtoxinA for chronic migraine treatment following the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol. Treatment responses were assessed by comparing changes in monthly headache days (MHD) to that of the 14 weeks prior to OnabotulinumtoxinA initiation. Additionally, Migraine Disability Assessment (MIDAS) scores were evaluated one month post-treatment.
Results:
The study included 63 female and female-assigned patients and 63 male and male-assigned patients, with a one-year follow-up period. Both patient groups demonstrated a statistically significant reduction in monthly headache days (MHD), with the female patients showing a more notable reduction (8.6 days compared to 7.8 days, P= 0.01). Furthermore, MIDAS scores also decreased in both groups with significance for the female patient group (3.7 points reduction compared to 2.4 points reduction in the total MIDAS score, P=0.017). These findings not only support OnabotulinumtoxinA as an effective treatment for chronic migraine but also emphasizes its pronounced efficacy in female and female-assigned patients.
Conclusions:
Our study supports the efficacy of OnabotulinumtoxinA in chronic migraine and highlights the potential need for gender-specific treatment protocols in chronic migraine management. However, given our current sample size limitation, larger population studies are needed to further confirm these findings.