OnabotulinumtoxinA shows promise for treating chronic migraine

OnabotulinumtoxinA (Botox) injections lead to a decrease in pain and improved quality of life in children with refractory migraines, according to findings from a study at an outpatient pediatric neurology/headache clinic. The 24 study participants were aged 12 to 17.5 years, and 87% were female. Approximately half of study participants had tried lifestyle modifications and used vitamin supplementation, and most were taking multiple medications. Approximately a quarter of patients were using pain control medications more than 3 times a week and had made emergency department visits for severe headaches. Depression and sleep disturbances were common.

Participants received an onabotulinumtoxinA injection series every 3 months for up to 12 months while maintaining prophylactic medications for chronic daily headache. Each treatment session involved intramuscular (IM) administration of 155 units of onabotulinumtoxinA at 31 fixed sites across 7 specific head and neck muscle groups. The remaining 45 units were administered according to a patient-specific follow-up pain protocol to allow for a more personalized approach.

At both 3- and 6-month posttreatment visits, scores on the Headache Impact Test and Migraine Disability Assessment decreased significantly from pretreatment levels. In addition, nearly half of patients reported improvement in quality-of-life measures, such as mood and concentration. Only 20% of patients had treatment-related adverse effects—mostly mild to moderate—such as gastrointestinal or renal symptoms or muscle weakness.

THOUGHTS FROM DR FARBER:

OnabotulinumtoxinA is not just for cosmetic purposes. Although onabotulinumtoxinA is currently off label (and not first line) for treating pediatric migraine, this condition should be added to the growing list of onabotulinumtoxinA’s uses, including spasticity, blepharospasm, strabismus, and neurogenic detrusor overactivity. Note that the IM injections are superficial and pinchlike rather than deep.

Reference:
Akbar A, Ford J, Tripathi S. The use of botulinum toxin type A in medically refractory pediatric patients with chronic daily headaches and its impact on the quality of life. J Child Neurol. Published online February 13, 2024. doi:10.1177/08830738241227061