Music medicine to improve the tolerability of onabotulinumtoxinA injections for chronic migraine: an open-label prospective cohort study.

Introduction: OnabotulinumtoxinA for migraine involves 31 injected repeated every 12 weeks. Tolerability is a significant factor impacting discontinuation. Music medicine has not been studied previously as an intervention to improve the tolerability of injections. Methodology: A single-centre prospective cohort study was undertaken. Following baseline, patients had music played during the procedure. Change in Visual Analogue Score (VAS) was assessed as the primary outcome. Results: Over 6 months, 50 patients were recruited with a median age of 42, and median duration of therapy of 13.5 months. 'Quiet calm classical music' was associated with a significant reduction in VAS (z=-4.7, p<0.001). Duration of therapy, disease state or headache frequency had no correlation with change in VAS. Conclusion: Music medicine is associated with a significant reduction in the procedural pain of onabotulinumtoxinA injections in prospective study. Further study is required to explore other modifiable factors to improve patient experience.