Dual Therapy With Anti-CGRP Monoclonal Antibodies and Botulinum Toxin for Migraine Prevention

Is There a Rationale?

Lanfranco Pellesi, MD; Thien P. Do, MD; Håkan Ashina, MD; Messoud Ashina, MD, PhD, DMSc; Rami Burstein, PhD


Headache. 2020;60(6):1056-1065. 

In This Article


Another important consideration for dual therapy is cost-effectiveness. Both therapies are highly expensive, with an estimated annual price of $8,500 for anti-CGRP mAbs and $6,128 for BTX-A.[85,86] In this context, it should be mentioned that a subgroup of individuals with CM was associated with a considerable cost-offset in the 6 months following treatment initiation with BTX-A.[86] Similarly, according to the estimation from a U.S. societal perspective, erenumab is likely to be cost-effective in migraine patients with a history of treatment failures.[87] However, it remains unknown whether dual therapy with anti-CGRP and BTX-A is a cost-effective therapy for some individuals with treatment-resistant migraine.