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Cephalalgia. 2016 Aug;36(9):862-74. doi: 10.1177/0333102415621294. Epub 2015 Dec 20.

Comparative effectiveness of onabotulinumtoxinA versus oral migraine prophylactic medications on headache-related resource utilization in the management of chronic migraine: Retrospective analysis of a US-based insurance claims database.

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Global Health Economics and Outcomes Research, Allergan plc, USA
Headache Center, Hofstra Northshore LIJ, USA.
Global Health Economics and Outcomes Research, Allergan plc, USA.
Consultant to Allergan plc., USA.
Department of Neurology, Mayo Clinic, USA.



Migraine, especially chronic migraine (CM), causes substantial disability; however, health care utilization has not been well characterized among patients receiving different migraine prophylactic treatments.


Using a large, US-based, health care claims database, headache-related health care utilization was evaluated among adults with CM treated with onabotulinumtoxinA or oral migraine prophylactic medications (OMPMs). Headache-related health care utilization was assessed at six, nine, and 12 months pre- and post-treatment. The primary endpoint was the difference between pre- and post-index headache-related health care utilization. A logistic regression model was created to test the difference between onabotulinumtoxinA and OMPM-treated groups for headache-related emergency department (ED) visits and hospitalizations.


Baseline characteristics were comparable between groups. The proportion of patients with ED visits or hospitalizations for a headache-related event decreased after starting onabotulinumtoxinA, but increased after starting an OMPM, for all three cohorts. Regression analyses showed that the odds of having a headache-related ED visit were 21%, 20%, and 19% lower and hospitalization were 47%, 48%, and 56% lower for the onabotulinumtoxinA group compared to the OMPM group for the six-month, nine-month, and 12-month post-index periods, respectively.


When compared with similar patients who initiated treatment with OMPM, onabotulinumtoxinA was associated with a significantly lower likelihood of headache-related ED visits and hospitalizations.


Chronic migraine; claims database; emergency department visits; hospitalizations; office visits; onabotulinumtoxinA; out-of-pocket expenses; payer costs; resource utilization

[Indexed for MEDLINE]

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