Erenumab and OnabotulinumtoxinA similarly reduce chronic migraine frequency, Erenumab improves mood and impact scores.

Chronic migraine (CM) represents a debilitating neurological disorder significantly impacting quality of life, often refractory to conventional treatments. Patients with CM experience 15 or more headache days per month, with at least eight meeting migraine criteria. Current preventive strategies, such as OnabotulinumtoxinA, target peripheral pain pathways but may not address all facets of the condition. The emergence of calcitonin gene-related peptide (CGRP) pathway inhibitors, like Erenumab, offers a novel mechanism by blocking the CGRP receptor, providing new therapeutic avenues. A direct comparison of these distinct approaches in a real-world setting is crucial to guide treatment decisions and optimize patient outcomes.

This prospective cohort study compared two parallel groups of chronic migraine patients over 6 months. One cohort received Erenumab 140 mg/month via subcutaneous injection, while the other received OnabotulinumtoxinA 195 U every 3 months via multiple intramuscular injections. Patients had no other preventive therapies or psychiatric/chronic pain comorbidities. Baseline and 6-month assessments included monthly headache days (MHD), monthly migraine days (MMD), and patient-reported outcomes using MIDAS, HIT-6, MSQ, BAI, and BDI-II scales. Efficacy was analyzed using paired t-tests, and linear regression models compared changes between groups.

A total of 114 patients (57 per group) were analyzed, with balanced baseline characteristics. Both treatments produced significant reductions in headache frequency at 6 months. Erenumab led to a -7.93 MHD reduction and -5.36 MMD reduction (p < 0.001), while OnabotulinumtoxinA resulted in a -6.00 MHD reduction and -4.31 MMD reduction (p < 0.001).

No statistically significant differences were found between therapies in the magnitude of headache reduction at 3 or 6 months. Significant improvements were observed in HIT-6 and MSQ scores in both cohorts (p < 0.05). The Erenumab group showed significant reductions in MIDAS, BDI, and BAI scores (p < 0.05). Differences between treatments were significant for MIDAS improvements at 3 and 6 months (p < 0.05).