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Evidence of and experience with the use of onabotulinumtoxinA in trigeminal neuralgia and primary headaches other than chronic migraine

Santos-Lasaosa S (1), Cuadrado ML (2), Gago-Veiga AB (3), Guerrero-Peral AL (4), Irimia P (5), Láinez JM (6), Leira R (7), Pascual J (8), Porta-Etessam J (2), Sánchez Del Río M (9), Viguera Romero J (10), Pozo-Rosich P (11).

(1) Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
(2) Unidad de Cefaleas, Instituto de Investigación Sanitaria San Carlos, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
(3) Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, España.
(4) Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario, Valladolid, España.
(5) Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, España.
(6) Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valencia, Universidad Católica de Valencia, Valencia, España.
(7) Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, España.
(8) Hospital Universitario Marqués de Valdecilla, Santander, España.
(9) Programa de Cefaleas, Departamento de Neurología, Hospital Rúber Internacional, Madrid, España.
(10) Unidad de Cefaleas, Unidad Clínica de Gestión de Neurociencias, Hospital Universitario Virgen de la Macarena, Sevilla, España.
(11) Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Investigación en Cefalea; VHIR, Universitat Autònoma de Barcelona, Barcelona, España.

Revisão:Neurologia

Data: 20/Nov/2017

Neurologia [ES]

INTRODUCTION:
In the field of headaches, onabotulinumtoxinA (onabotA) is well established as a treatment for chronic migraine (CM). In recent years, it has been used increasingly to treat other primary headaches (high-frequency episodic migraine, trigeminal-autonomic cephalalgias, nummular headache) and trigeminal neuralgia.

As this treatment will progressively be incorporated in the management of these patients, we consider it necessary to reflect, with a fundamentally practical approach, on the possible indications of onabotA, beyond CM, as well as its administration protocol, which will differ according to the type of headache and/or neuralgia.

DEVELOPMENT:
This consensus document was drafted based on a thorough review and analysis of the existing literature and our own clinical experience. The aim of the document is to serve as guidelines for professionals administering onabotA treatment.

The first part will address onabotA's mechanism of action, and reasons for its use in other types of headache, from a physiopathological and clinical perspective. In the second part, we will review the available evidence and studies published in recent years.

We will add an "expert recommendation" based on our own clinical experience, showing the best patient profile for this treatment and the most adequate dose and administration protocol.

CONCLUSION:
Treatment with onabotA should always be individualised and considered in selected patients who have not responded to conventional therapy.

CITAÇÃO DO ARTIGO  Neurologia. 2017 Nov 20. pii: S0213-4853(17)30319-5. doi: 10.1016/j.nrl.2017.09.003

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