Rials Unit, University of Birmingham, Birmingham, UK; 5Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK The Journal of Headache and Pain 2017, 18(Suppl 1):P11 Objectives To assess the effects of botulinum toxins versus placebo, active remedy or various dose for prevention of episodic or chronic migraine in adults. Background Several migraine individuals endure prolonged and frequent migraine attacks regardless of optimised acute and prophylactic therapies. Botulinum toxin sort A has been licensed for use in chronic migraine in some nations, primarily based largely on two commercially sponsored trials. Procedures Relevant trials were identified via electronic searches of Cochrane Central Register of Propofol manufacturer controlled Trials, Medline, Embase, andFig. 1 (abstract P9). FORWARD Study methodologyThe Journal of Headache and Discomfort 2017, 18(Suppl 1):Web page 27 oftrials registries, handsearching reference lists and citation searches on PSEM 89S custom synthesis essential publications, and correspondence with suppliers. We integrated randomised, double-blind, controlled trials. Twelve week time-point data following final round of remedy was analysed. Benefits Twenty-eight trials (N=4192) had been eligible for inclusion. No trial carried out long-term follow up. All larger trials (N100) have been at higher danger industrial sponsorship bias, otherwise trial top quality was mixed. Botulinum toxin was compared with placebo in 23 trials. 4 trials (N=1497) of botulinum toxin in chronic migraineurs showed a reduced frequency of -3.1 migraine daysmonth (95 self-confidence interval (CI) -4.73 to -1.41) compared with placebo. Addition of a single trial (418 participants) in episodic migraine lowered this pooled estimate of impact to -2.39 daysmonth (95 CI -4.02 to -0.76), nonetheless in favour of botulinum toxin. Secondary efficacy measures had been inconsistent. Information for quantity of migraine attacks from six trials which includes chronic and episodic migraineurs showed no substantial involving group difference (P=0.30), but severity of migraine (10 cm visual analogue scale), was enhanced by -3.30 points (95 CI -4.16 to -2.45) far more with active therapy. Worldwide assessment and good quality of life measures had been poorly reported. Botulinum toxin had a relative threat of remedy associated adverse events of twice that noticed for placebo (2.18, 95 CI 1.73 to 2.75). Insufficient information was available to establish any dose-response relationship for any outcome measure. 3 trials of comparisons with oral prophylactic agents independently reported no significant amongst group differences to get a selection of diary information outcomes but meta-analysis was not attainable. Compared with oral remedies, botulinum toxin showed a lowered relative threat of treatment-related adverse events of 0.76 (95 CI 0.59 to 0.98). Conclusions In chronic migraine, botulinum toxin type A reduces frequency of migraine by 3 daysmonth, reduces migraine severity by 30 and has a favourable safety profile compared with other preventative drugs. Evidence to support or refute the efficacy of botulinum toxin in episodic migraine was not identified.P13 Sphenopalatine ganglion block employing Tx360 device. 1st results in refractory chronic cluster headache in Spain Jose M Sanchez, Maria Rico, Maria Castanon, Elena Ameijide Hospital Universitario Central de Asturias, Neurology, Oviedo, Spain Correspondence: Jose M Sanchez ([email protected]) The Journal of Headache and Pain 2017, 18(Suppl 1):P13 Background Despite existing preventive remedies pretty much 20 of pat.