Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic migraine

Abstract

Objective The main objective of this pilot study was to investigate the safety of administering onabotulinumtoxinA towards the sphenopalatine ganglion in 10 patients with intractable chronic migraine with an open, uncontrolled design. We also collected efficacy data to provide an indication as to whether future placebo-controlled studies should be performed. Method In a prospective, open-label, uncontrolled study after one-month baseline, we performed bilateral injections of 25 IU onabotulinumtoxinA (total dose 50 IU) toward the sphenopalatine ganglion in a single outpatient session in 10 patients with intractable migraine with a follow-up of 12 weeks. The primary outcome was adverse events and the main efficacy outcome was frequency of moderate and severe headache days in month 2 post-treatment compared to baseline. Results All 10 patients experienced a total of 25 adverse events. The majority of these were different types of local discomfort in the face and jaw, and none were classified as serious. In an intention-to-treat analysis of the main efficacy outcome, a statistically significant reduction of moderate and severe headache days in baseline versus month 2 was observed (16.3 ± 6.2 days baseline versus 7.6 ± 7.6 days month 2, p = 0.009). Eight out of 10 patients experienced an at least 50% reduction of moderate and severe headache days compared to baseline. Conclusion The result warrants randomised, placebo-controlled studies to establish both safety and efficacy of this potential novel treatment of chronic migraine.

Keywords: Chronic migraine; botulinum toxin; headache; pterygopalatine ganglion; sphenopalatine ganglion.

Figure 1.

Novel injection device to perform surgical navigation-assisted administration of drugs.

Figure 2.

Main efficacy measure. Mean moderate and severe headache days per month for baseline and after one single, bilateral onabotulinumtoxinA treatment of the sphenopalatine ganglion, intention-to-treat analysis (n = 10). BL: baseline; M: month (28 days). P value for each month compared to baseline.