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August 6, 2026ToxinsOpen Access

Effectiveness of Onabotulinumtoxin-A in Patients with Chronic Migraine and Previous CGRP-mAb Treatment Failure: A Multicentre 6-Month Real-World Experience

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Authors

MSMarcello SilvestroMAMaria AlbaneseIOIlaria Orologio

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Overview

Multicentre trial shows BoNT-A reduces headache days in chronic migraine patients after CGRP-mAb failure, suggesting new treatment options.

Key Points

  • Evaluate the effectiveness of onabotulinumtoxin-A in patients with chronic migraine who previously failed CGRP-mAb treatment.
  • Prospective, observational, non-randomized multicentre study
  • Enrolled patients with chronic migraine failing ≥3 oral preventive therapies and ≥1 CGRP-mAb
  • Administered BoNT-A every three months for six months following the PREEMPT paradigm
  • Monthly headache days decreased from 22.83 to 14.55 by six months (p < 0.001)
  • 30% and 45% of participants achieved ≥50% reduction in headache days at three and six months, respectively
  • Medication-overuse headache prevalence decreased from 81.1% to 43.4% by six months

Cite This Study

Silvestro et al. (2026) studied this question.

synapsesocial.com/papers/6a74379d764cddc9499d50bchttps://doi.org/10.3390/toxins18080342
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Real-world effectiveness of onabotulinumtoxinA as first-line treatment in chronic migraine and sequential transition to anti-CGRP monoclonal antibodies: a retrospective multicenter study.2026
  2. 2Combination preventive therapy with onabotulinumtoxinA and atogepant for chronic migraine: A 24-week, prospective, real-world evaluation (SYNERGY study)2025
  3. 3Comparative effectiveness and tolerability of calcitonin gene‐related peptide (<scp>CGRP)</scp> monoclonal antibodies and <scp>onabotulinumtoxinA</scp> in chronic migraine: A multicenter, real‐world study in Taiwan2024 · 3 citations
  4. 4Reducing the Impact of Headache and Allodynia Score in Chronic Migraine: An Exploratory Analysis from the Real-World Effectiveness of Anti-CGRP Monoclonal Antibodies Compared to Onabotulinum Toxin A (RAMO) Study2024 · 6 citations
  5. 5Beyond headache: Cognitive improvement in patients with migraine responding to anti-CGRP monoclonal antibodies or botulinum toxin2026