Comparison of different treatment strategies for medication overuse headache: a systematic review and meta-analysis
Fernanda Moraes Tamashiro1, Beatriz Guerreiro Otoboni2, Jade Lingiardi Altoé2, Maria Carolina Sawadi Guizilini2, Khauana Carvalho de Lima2, Jeane Carvalho de Melo1, Catarina Nobile Portezan3, Vitor Kendi Tsuchiya Sano4, Artur Menegaz de Almeida5
1University of Buenos Aires, 2University of Maringa, UniCesumar, 3University of Maringa Unicesumar, 4Federal University of Acre, 5Federal University of Mato Grosso
Objective:
We sought to evaluate the efficacy and safety of different monoclonal antibodies targeting the CGRP and botulinum toxin A for treating medication-overuse headache (MOH) and migraine.
Background:
There are many treatment options for medication overuse headaches, including botulinum toxin A and monoclonal antibodies, both acting through the calcitonin gene-related peptide (CGRP) pathway. However, there is inconclusive data regarding their efficacy.
Design/Methods:
We searched “Medline”, “Cochrane”, and “Scopus” for randomized controlled trials. Continuous outcomes were assessed through mean difference (MD) with 95% confidence intervals. Statistical significance was set as p-values < 0.05. Heterogeneity was examined using the I2 statistics. For those outcomes, the Mantel-Haenszel random-effects model was applied. We used R software version 4.3.2 and the extension package “meta” for all statistical analyses.
Results:
A total of 10 randomized controlled trials and 3925 patients were included, of whom 2786 (70,98%) received monoclonal antibodies and 562 (14,3%) received botulinum toxin A, including erenumab, fremanezumab, and eptinezumab for both MOH and migraine treatments. During the follow-up period, patients treated with botulinum toxin experienced a decrease in headache compared to placebo (MD -1.90; 95% CI -2.68 to -1.12; P= 0.000002; I² = 0%). Furthermore, the use of monoclonal antibodies also presented significantly better results compared to placebo for both monthly migraine days (MD -2.65; 95% CI -3.19 to -2.12; P < 0.000001; I² = 77%) and monthly headache days (MD -2.33; 95% CI -2.85 to -1.81; P < 0.000001; I² = 95%).
Conclusions:
In this meta-analysis, we concluded that both monoclonal antibodies and botulinum toxin A injections effectively achieved monthly headache and monthly migraine reductions.
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