Adding CGRP Antibodies to Botox Improves Chronic Migraine Control
Adding CGRP monoclonal antibody therapy to ongoing onabotulinumtoxinA (Botox) treatment provided additional clinically meaningful migraine reduction in chronic migraine patients in a real-world clinical setting.
Quick Facts
What This Study Found
Combination of CGRP mAbs with onabotulinumtoxinA reduced monthly headache days by an additional 3.5-4.0 beyond Botox alone, with 45.1% achieving meaningful disability improvement.
Key Numbers
257 patients; 21.5 MHDs pre-Botox; 12.1 pre-CGRP mAb; 3.5-4 MHD reduction; 45.1% MIDAS response; 78% erenumab; 28% adverse events
How They Did This
Retrospective longitudinal chart review of 257 adults with chronic migraine at one clinical site, tracking outcomes at 3, 6, 9, and 12 months after adding CGRP mAb to ongoing Botox therapy.
Why This Research Matters
Many chronic migraine patients don't achieve adequate relief from a single preventive therapy. This real-world evidence supports combining two different mechanism-based treatments for better outcomes.
The Bigger Picture
Chronic migraine is a debilitating condition that often requires multiple treatments. This study provides real-world evidence supporting a dual-mechanism approach, combining Botox (which works on nerve signaling) with CGRP antibodies (which block the pain peptide pathway) for patients who need additional relief.
What This Study Doesn't Tell Us
Retrospective design without a control group. Single clinical site. Predominantly erenumab (78%) with limited data on other mAbs. No randomization or blinding.
Questions This Raises
- ?Would a randomized controlled trial confirm these combination benefits?
- ?Are there specific patient characteristics that predict better response to combination therapy?
- ?Is there a difference in combination efficacy between the different CGRP antibodies?
Trust & Context
- Key Stat:
- 3.5-4.0 fewer monthly headache days Additional reduction when CGRP mAbs were added to ongoing onabotulinumtoxinA therapy
- Evidence Grade:
- Real-world retrospective study with a large sample (n=257) but no control group. Provides moderate-quality evidence supporting combination therapy.
- Study Age:
- Published in 2021, when CGRP antibodies were relatively new additions to the migraine treatment landscape.
- Original Title:
- Real-World Evidence for Control of Chronic Migraine Patients Receiving CGRP Monoclonal Antibody Therapy Added to OnabotulinumtoxinA: A Retrospective Chart Review.
- Published In:
- Pain and therapy, 10(2), 809-826 (2021)
- Authors:
- Blumenfeld, Andrew M(3), Frishberg, Benjamin M, Schim, Jack D, Iannone, Ashley, Schneider, Gary, Yedigarova, Larisa, Manack Adams, Aubrey
- Database ID:
- RPEP-05289
Evidence Hierarchy
Watches what happens naturally without intervening.
What do these levels mean? →Frequently Asked Questions
Can you take Botox and CGRP antibodies together for migraines?
Yes. This study of 257 patients found that adding a CGRP antibody to ongoing Botox treatment was well-tolerated and provided additional headache reduction of 3.5-4.0 fewer monthly headache days beyond what Botox alone achieved.
What were the side effects of combining these treatments?
The combination was generally well-tolerated. Constipation was the most common side effect (9% of patients). Patients were more likely to stop the CGRP antibody (23%) than Botox (3%) during the study period. No new or unexpected safety issues were identified.
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Cite This Study
https://rethinkpeptides.com/research/RPEP-05289APA
Blumenfeld, Andrew M; Frishberg, Benjamin M; Schim, Jack D; Iannone, Ashley; Schneider, Gary; Yedigarova, Larisa; Manack Adams, Aubrey. (2021). Real-World Evidence for Control of Chronic Migraine Patients Receiving CGRP Monoclonal Antibody Therapy Added to OnabotulinumtoxinA: A Retrospective Chart Review.. Pain and therapy, 10(2), 809-826. https://doi.org/10.1007/s40122-021-00264-x
MLA
Blumenfeld, Andrew M, et al. "Real-World Evidence for Control of Chronic Migraine Patients Receiving CGRP Monoclonal Antibody Therapy Added to OnabotulinumtoxinA: A Retrospective Chart Review.." Pain and therapy, 2021. https://doi.org/10.1007/s40122-021-00264-x
RethinkPeptides
RethinkPeptides Research Database. "Real-World Evidence for Control of Chronic Migraine Patients..." RPEP-05289. Retrieved from https://rethinkpeptides.com/research/blumenfeld-2021-realworld-evidence-for-control
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.