Manejo da toxina botulínica comparada a outras terapias na melhora da dor em pacientes com enxaqueca crônica: uma revisão sistemática com metanálise

Abstract

Objective: To evaluate the effectiveness of Botulinum Toxin type A (BTX-A) in reducing the frequency of pain in adults with primary Chronic Migraine (CM), comparing it with other therapies or placebo treatment. Methodology: A systematic review with meta-analysis of randomized clinical trials was carried out, between February 2023 and April 2024, using the databases PubMed via Medline, Cochrane Library, Lilacs via VHL, Embase, Web of Science, Google Scholar and Clinical Trials , the search terms were included in the descriptors, found in the Health Sciences Descriptors (DeCS/MeSH) or in Emtre, combined with the Boolean operators AND and OR, with the formulation of the question using the acronym PICO and a process carried out by double independent reviewers. The first stage consisted of screening studies by title and abstract, the second by full text, both using the Rayyan® platform. Risk of bias assessed by RoB 2.0 and certainty of evidence by the GRADE tool. Then, random effects meta-analysis was conducted to estimate the summary mean difference with 95% confidence intervals. Results: 867 references were found, after screening, 11 articles were selected that met the eligibility criteria. Of these, a total of 4 were used for meta-analysis, all of which had placebo as a comparator group. The results regarding the outcomes of frequency of migraine days, migraine episodes and headache episodes were statistically insignificant, therefore, it could not be stated that the intervention favors the outcomes studied. Regarding the outcome of the frequency of headache days, individuals who used BTX-A had a reduction of -1.51 headache days, this result was statistically significant with heterogeneity of 0. As well as, for the impact of pain, classified using the Headache Impact Test (HIT-6) scale, a reduction of -2.24 points in the evaluation score was observed for the group treated by BTX-A compared to the placebo group, a result considered statistically significant with a heterogeneity of 0% and a value of p <0.05, indicating effectiveness of treatment with the studied intervention for both outcomes. Conclusion: BTX-A compared to placebo therapy was found to be effective in treating headache and pain impact in patients diagnosed with CM.