This protocol targets vestibular migraine in patients with chronic migraine who require escalation of preventive treatment. Both topiramate and onabotulinumtoxinA have evidence of efficacy in chronic migraine, including in the presence of medication overuse.
Escalation is indicated when prophylaxis with topiramate has failed to achieve a reduction of migraine attack frequency of 50% or more. This unmet target is the specific criterion that drives progression to the next treatment step described here.
The next step centres on OnabotulinumtoxinA, administered at scheduled intervals. The complete injection protocol, continuation criteria, and decision points are available in the full structured regimen.
The primary target is a measurable improvement in chronic migraine — specifically a reduction in headache days — assessed at the third treatment cycle.
DOI: 10.1177/2514183X1882337
Topiramate and onabotulinumtoxinA are effective in chronic migraine with or without medication overuse.
OnabotulinumtoxinA is effective in the therapy of chronic migraine with and without overuse of acute medication.
OnabotulinumtoxinA must be injected at 3-month intervals in order to achieve a long-lasting and increasing effect.
If there is no improvement in chronic migraine after the third cycle, treatment should be discontinued.
View source ↗