Effects of the onabotulinumtoxinA follow-up delay in migraine course during the COVID-19 lockdown

DOI: https://doi.org/10.1007/s10072- 021- 05180- 8

Abstract-Summary We aim to evaluate the impact of onabotulinumtoxinA follow-up delay in migraine during COVID-19 pandemic.

Subjective worsening, intensity of migraine attacks, and frequency of headache and migraine were retrospectively compared between patients with unmodified and interrupted onabotulinumtoxinA follow-up in Headache Units.

Patients with uninterrupted follow-up during lockdown presented 7.6 and 8.1 less monthly days with headache (adjusted p = 0.017) and migraine attacks (adjusted p = 0.009) compared to patients whose follow-up was interrupted, respectively.

Involuntary delay of onabotulinumtoxinA follow-up in patients with migraine due to COVID-19 pandemic was associated with a higher frequency of headache and migraine attacks.

Extended: The objective of this study was to determine whether missing in- person appointments for the onabotulinumtoxinA planned follow-up have resulted in a resurgence of migraine headaches during the COVID-19 lockdown.

Introduction There has been a marked reduction in the number of in-person visits as well as in- person treatments [313] in order to reduce widespread infections [314, 315].

The number of face-to-face appointments for in-person treatments such as ona-

botulinumtoxinA have been drastically reduced.

Little is known about the impact of onabotulinumtoxinA delay in the migraine

course during the pandemic and lockdown.

The objective of this study was to determine whether missing in-person appoint- ments for the onabotulinumtoxinA planned follow-up have resulted in a resurgence of migraine headaches during the COVID-19 lockdown.

Methods A retrospective cross-sectional study comparing migraine course in patients treated with onabotulinumtoxinA before and during the COVID-19 lockdown was car- ried out.

Four characteristics were evaluated during the lockdown: subjective worsening of the migraine, intensity of the migraine attacks, and number of monthly days with headache and migraine.

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COVID-19 and SARS-COV2 Vaccines

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Number of monthly days with headache contained any type of headache, includ-

ing migraine, and another variable was considered for the days with migraine.

The study population were patients with migraine under onabotulinumtoxinA treatment that were followed-up at the Headache Units of three Spanish academic hospitals.

For the analysis of subjective worsening of migraine, a logistic regression model was employed, while the other three characteristics (intensity of migraine attacks and number of monthly days with migraine and headache) were evaluated with a Generalized Linear Model (GLM) following a Gaussian distribution, using as response variable the difference between the numeric value during the lockdown and the value before the lockdown.

Results With respect to number of monthly days with headache, compared to the patients who had no chance to continue their follow-up during the COVID-19 lockdown, a significant decrease between 7 and 9 days per month was observed in the patients who voluntarily delayed their treatment (β = −8.7, corrected p = 0.017) and those who continued with the planned follow-up (β = −7.6, corrected p = 0.017).

A significant higher frequency of headache was found in patients with higher

duration of migraine (β = 0.2, corrected p = 0.040).

Regarding the migraine frequency, compared to the patients with involuntary delayed follow-up, a reduction of 8–9 days per month in patients with the planned onabotulinumtoxinA follow-up (β = −8.1, corrected p = 0.009) and with voluntary delay of the treatment administration (β = −8.4, corrected p = 0.011) was also found. Discussion Patients experiencing involuntary delay in onabotulinumtoxinA administration dur- ing the pandemic have suffered a remarkably higher number of monthly days with headache and migraine attacks.

The patients who could continue with the expected onabotulinumtoxinA follow- up suffered from headache or migraine attacks between 7.5 and 8.5 days per month less in comparison with the patients who were unable to go to the in-person appointment.

In the same direction, our results demonstrate that onabotulinumtoxinA delay has also caused downside effects on patients with other chronic pain conditions such as chronic migraine.

Considering that anxiety, depression, and especially stress levels have increased throughout the lockdown related to the COVID-19 pandemic [316], the onabotu- linumtoxinA follow-up would be important not only to reduce frequency of head- ache and migraine but also to prevent a worsening of the clinical course associated with the psychiatric comorbidity.

Conclusion Involuntary delay in onabotulinumtoxinA treatment in patients with migraine was associated with higher frequency of migraine attacks and headache.

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5 Future Directions

The negative impact of onabotulinumtoxinA delay in these patients might sug- gest that face-to-face treatment administration following safety recommendations could be a good option for management of chronic or high-frequency episodic migraine during lockdown.

Clinical Implications The follow-up of onabotulinumtoxinA during COVID-19 lockdown was interrupted in approximately a third of patients with migraine, with a negative effect in those patients with involuntary delay (approximately 40% of the patients with interrupted follow-up in our sample).

Patients with involuntarily interrupted follow-up presented 7–9 more monthly days with headache and migraine attacks compared to patients with voluntary delay and uninterrupted follow-up during COVID-19 lockdown.

Acknowledgement A machine generated summary based on the work of Gonzalez-Martinez, Alicia; Planchuelo-Gómez, Álvaro; Guerrero, Ángel L; García-Azorín, David; Santos- Lasaosa, Sonia; Navarro-Pérez, María Pilar; Odriozola-González, Paula; Irurtia, María Jesús; Quintas, Sonia; de Luis-García, Rodrigo; Gago-Veiga, Ana Beatriz 2021 in Neurological Sciences.

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