Excellent Response to OnabotulinumtoxinA: Different Definitions, Different Predictors

Raffaele Ornello, Carlo Baraldi, Fayyaz Ahmed, Andrea Negro, Anna Maria Miscio, Antonio Santoro, Alicia Alpuente, Antonio Russo, Marcello Silvestro, Sabina Cevoli, Nicoletta Brunelli, Fabrizio Vernieri, Licia Grazzi, Luca Pani, Anna Andreou, Giorgio Lambru, Ilaria Frattale, Katharina Kamm, Ruth Ruscheweyh, Marco RussoPaola Torelli, Elena Filatova, Nina Latysheva, Anna Gryglas-Dworak, Marcin Straburzyński, Calogera Butera, Bruno Colombo, Massimo Filippi, Patricia Pozo-Rosich, Paolo Martelletti, Simona Guerzoni, Simona Sacco

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The identification of patients who can benefit the most from the available preventive treatments is important in chronic migraine. We explored the rate of excellent responders to onabotulinumtoxinA in a multicenter European study and explored the predictors of such response, according to different definitions. A pooled analysis on chronic migraineurs treated with onabotulinumtoxinA and followed-up for, at least, 9 months was performed. Excellent responders were defined either as patients with a ≥75% decrease in monthly headache days (percent-based excellent responders) or as patients with <4 monthly headache days (frequency-based excellent responders). The characteristics of excellent responders at the baseline were compared with the ones of patients with a <30% decrease in monthly headache days. Percent-based excellent responders represented about 10% of the sample, whilst frequency-based excellent responders were about 5% of the sample. Compared with non-responders, percent-based excellent responders had a higher prevalence of medication overuse and a higher excellent response rate even after the 1st and the 2nd injection. Females were less like to be frequency-based excellent responders. Chronic migraine sufferers without medication overuse and of female sex may find fewer benefits with onabotulinumtoxinA. Additionally, the excellent response status is identifiable after the first cycle.
Original languageEnglish
Pages (from-to)10975
Number of pages1
JournalInternational Journal of Environmental Research and Public Health
Issue number17
Publication statusPublished - 1 Sept 2022


  • Onabotulinumtoxina
  • Predictors Of Response
  • Chronic Migraine
  • Excellent Responders
  • Humans
  • Headache
  • Chronic Disease
  • Treatment Outcome
  • Female
  • Migraine Disorders
  • Botulinum Toxins, Type A


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