The Use of OnabotulinumtoxinA for the Treatment of Chronic Migraine During Pregnancy: An American Headache Society Survey Study
Justin Nofar1, Kendra Davis1, Paul Mathew2, Ashhar Ali1
1Neurology, Henry Ford Health, 2Harvard Medical School/Mass General Brigham/Atrius Health
Objective:
To generate a statistical snapshot of physicians’ perspectives and treatment practices regarding use of onabotulinumtoxinA (onabotA) for treating chronic migraine during pregnancy.
Background:
OnabotA is an FDA-approved neurotoxin for treating chronic migraine. However, limited data exists regarding the safety of onabotA in pregnancy. The therapeutic options for migraine during pregnancy are currently limited and few studies have been conducted to explore physicians’ practices regarding the use of botulinum toxin in pregnancy.
Design/Methods:
A 15-question survey exploring physicians’ clinical practices using botulinum toxin injections for chronic migraine was distributed online to members of the American Headache Society. The final 4 questions pertained to use in pregnancy. Descriptive analysis was performed.
Results:
A total of 168 respondents (162 from the United States and 6 from Canada) completed the survey (response rate 10.1% [168/1665]). Of the respondents, 96 (58%) reported not using OnabotA during pregnancy; 97 (59%) reported continuing use of onabotA while a patient is actively trying to become pregnant; 94 (57%) reported discontinuation of onabotA treatment when a patient become pregnant; 117 (71%) reported that they have or would consider resuming onabotA treatment during pregnancy should a patient experience refractory headache after discontinuation of the treatment.
Conclusions:
Of the providers sampled, a slight majority avoided use of onabotA during pregnancy, however would use or consider using onabotA should the patient develop refractory headache after discontinuation of onabotA due to pregnancy. Additionally, the majority of providers did not discontinue onabotA while a patient is actively trying to become pregnant.