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Neuropediatrics 2022; 53(05): 344-350
DOI: 10.1055/a-1832-9168
Original Article

Is Botox Right for Me: When to Assess the Efficacy of the Botox Injection for Chronic Migraine in Pediatric Population

Ajay Goenka
1   Department of Neurology, Dayton Children Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States
2   Department of Pediatrics, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, United States
,
Sarah G. Yu
2   Department of Pediatrics, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, United States
,
Monica C. George
2   Department of Pediatrics, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, United States
,
Mahesh Chikkannaiah
1   Department of Neurology, Dayton Children Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States
2   Department of Pediatrics, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, United States
,
Sarah MacDonald
1   Department of Neurology, Dayton Children Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States
,
Adrienne Stolfi
2   Department of Pediatrics, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, United States
,
Gogi Kumar
1   Department of Neurology, Dayton Children Hospital, Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States
2   Department of Pediatrics, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, United States
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Abstract

Botulinum toxin type A (BoNT-A) has shown to be a safe and effective treatment for children with chronic migraines. Our study was to assess the efficacy of the Onabotulinum toxin type A at different intervals after initiation of therapy. We conducted a retrospective and prospective analysis of 34 patients at a children's hospital where children received four rounds of the BoNT-A therapy for the treatment of chronic migraine. Among the 34 patients, 25 patients (age range: 13–21 years), who responded to the BoNT-A therapy, were included in the analysis. Patients received standard 31 injection, 155 unit's protocol. Patients were assessed every 3 months after their initial injection. Reasons for discontinuation of therapy were analyzed. After the first two BoNT-A sessions, significant improvement was observed with a decrease in headache frequency and intensity (p < 0.001). There was further reduction in headache frequency and intensity with the fourth round of BoNT-A therapy, with comparative analysis between the second and fourth round showing a p-value of <0.001. In terms of reduction of emergency room visits and hospitalization, a significant improvement was seen after the third round of BoNT-A therapy (p < 0.01). A significant decrease in the number of abortive and preventive medications was seen after the second round of BoNT-A therapy (p < 0.001). The efficacy of BoNT-A treatment in decreasing headache frequency, intensity, and the number of abortive and preventive medications can be assessed effectively after two treatment sessions. This trend continued to be observed with additional third and fourth sessions.

Keywords

onabotulinum toxin type A - migraine - pediatrics

Author Contributions

A.G.: drafting/revising the manuscript. S.G.Y.: drafting/revising the manuscript. M.C.G.: revising the manuscript. M.C.: drafting/revising the manuscript. S.M.: revising the manuscript. A.S.: statical analysis. G.K.: drafting/revising the manuscript.




Publikationsverlauf

Eingereicht: 20. Oktober 2021

Angenommen: 19. April 2022

Accepted Manuscript online:
22. April 2022

Artikel online veröffentlicht:
21. Juli 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Marcelo R, Freund B. The efficacy of botulinum toxin in pediatric chronic migraine: a literature review. J Child Neurol 2020; 35 (12) 844-851
    CrossrefPubMedGoogle Scholar
  • 2 Santana L, Liu C. Experience of botulinum toxin A injections for chronic migraine headaches in a pediatric chronic pain clinic. J Pediatr Pharmacol Ther 2021; 26 (02) 151-156
    PubMedGoogle Scholar
  • 3 Wöber-Bingöl C. Epidemiology of migraine and headache in children and adolescents. Curr Pain Headache Rep 2013; 17 (06) 341
    CrossrefPubMedGoogle Scholar
  • 4 Bigal ME, Arruda MA. Migraine in the pediatric population–evolving concepts. Headache 2010; 50 (07) 1130-1143
    CrossrefPubMedGoogle Scholar
  • 5 Youssef PE, Mack KJ. Episodic and chronic migraine in children. Dev Med Child Neurol 2020; 62 (01) 34-41
    CrossrefPubMedGoogle Scholar
  • 6 Gozubatik-Celik RG, Ozturk M. Evaluation of quality of life and anxiety disorder in children and adolescents with primary headache. Med Bull Haseki 2021; 59 (02) 167-171
    CrossrefPubMedGoogle Scholar
  • 7 Shah S, Calderon MD, Wu W, Grant J, Rinehart J. Onabotulinumtoxin A (BOTOX) for ProphylaCTIC treatment of pediatric migraine: a retrospective longitudinal analysis. J Child Neurol 2018; 33 (09) 580-586
    CrossrefPubMedGoogle Scholar
  • 8 Ali SS, Bragin I, Rende E, Mejico L, Werner KE. Further evidence that onabotulinum toxin is a viable treatment option for pediatric chronic migraine patients. Cureus 2019; 11 (03) e4343
    PubMedGoogle Scholar
  • 9 Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Accessed June 7, 2021 at: https://ichd-3.org/1-migraine/1-1-migraine-without-aura/
    PubMedGoogle Scholar
  • 10 Burstein R, Zhang X, Levy D, Aoki KR, Brin MF. Selective inhibition of meningeal nociceptors by botulinum neurotoxin type A: therapeutic implications for migraine and other pains. Cephalalgia 2014; 34 (11) 853-869
    CrossrefPubMedGoogle Scholar
  • 11 Escher CM, Paracka L, Dressler D, Kollewe K. Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Ther Adv Neurol Disord 2017; 10 (02) 127-135
    CrossrefPubMedGoogle Scholar
  • 12 Begasse de Dhaem O, Gharedaghi MH, Rizzoli P. Modifications to the PREEMPT protocol for onabotulinumtoxinA injections for chronic migraine in clinical practice. Headache 2020; 60 (07) 1365-1375
    CrossrefPubMedGoogle Scholar
  • 13 Dodick DW, Turkel CC, DeGryse RE. et al; PREEMPT Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache 2010; 50 (06) 921-936
    CrossrefPubMedGoogle Scholar
  • 14 Cder FDA. Center for drug evaluation and research approval package for. APPLICATION NUMBER: BLA 2010; 103000: S-5215
    PubMedGoogle Scholar
  • 15 Injection workbook for chronic migraine: guidance for identifying BOTOX candidates, the injection procedure, and discussing treatment with patients. Accessed May 3, 2022 at: https://www.botoxmedical.com/Common/Assets/APC55BL15%20Injection%20Workbook%20FINAL%20elec.pdf
    PubMedGoogle Scholar
  • 16 Bendtsen L, Sacco S, Ashina M. et al. Guideline on the use of onabotulinumtoxinA in chronic migraine: a consensus statement from the European Headache Federation. J Headache Pain 2018; 19 (01) 91
    CrossrefPubMedGoogle Scholar
  • 17 Winner PK, Kabbouche M, Yonker M, Wangsadipura V, Lum A, Brin MF. A randomized trial to evaluate onabotulinumtoxinA for prevention of headaches in adolescents with chronic migraine. Headache 2020; 60 (03) 564-575
    CrossrefPubMedGoogle Scholar
  • 18 Chan VW, McCabe EJ, MacGregor DL. VW C. Botox treatment for migraine and chronic daily headache in adolescents. J Neurosci Nurs 2009; 41 (05) 235-243
    CrossrefPubMedGoogle Scholar
  • 19 Kabbouche M, O'Brien H, Hershey AD. OnabotulinumtoxinA in pediatric chronic daily headache. Curr Neurol Neurosci Rep 2012; 12 (02) 114-117
    CrossrefPubMedGoogle Scholar
  • 20 Shah S, Calderon MD, Crain N, Pham J, Rinehart J. Effectiveness of onabotulinumtoxinA (BOTOX) in pediatric patients experiencing migraines: a randomized, double-blinded, placebo-controlled crossover study in the pediatric pain population. Reg Anesth Pain Med 2021; 46 (01) 41-48
    CrossrefPubMedGoogle Scholar
  • 21 Dodick DW, Mauskop A, Elkind AH, DeGryse R, Brin MF, Silberstein SD. BOTOX CDH Study Group. Botulinum toxin type a for the prophylaxis of chronic daily headache: subgroup analysis of patients not receiving other prophylactic medications: a randomized double-blind, placebo-controlled study. Headache 2005; 45 (04) 315-324
    CrossrefPubMedGoogle Scholar
  • 22 Hansson-Hedblom A, Axelsson I, Jacobson L, Tedroff J, Borgström F. Economic consequences of migraine in Sweden and implications for the cost-effectiveness of onabotulinumtoxinA (Botox) for chronic migraine in Sweden and Norway. J Headache Pain 2020; 21 (01) 99
    CrossrefPubMedGoogle Scholar
  • 23 Hollier-Hann G, Curry A, Onishchenko K. et al. Updated cost-effectiveness analysis of onabotulinumtoxinA for the prevention of headache in adults with chronic migraine who have previously received three or more preventive treatments in the UK. J Med Econ 2020; 23 (01) 113-123
    CrossrefPubMedGoogle Scholar
  • 24 Ahmed F, Gaul C, García-Moncó JC, Sommer K, Martelletti P. REPOSE Principal Investigators. An open-label prospective study of the real-life use of onabotulinumtoxinA for the treatment of chronic migraine: the REPOSE study. J Headache Pain 2019; 20 (01) 26
    CrossrefPubMedGoogle Scholar
  • 25 Aurora SK, Dodick DW, Turkel CC. et al; PREEMPT 1 Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia 2010; 30 (07) 793-803
    CrossrefPubMedGoogle Scholar
  • 26 Aurora SK, Winner P, Freeman MC. et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache 2011; 51 (09) 1358-1373
    CrossrefPubMedGoogle Scholar
  • 27 Blumenfeld A, Silberstein SD, Dodick DW, Aurora SK, Turkel CC, Binder WJ. Method of injection of onabotulinumtoxinA for chronic migraine: a safe, well-tolerated, and effective treatment paradigm based on the PREEMPT clinical program. Headache 2010; 50 (09) 1406-1418
    CrossrefPubMedGoogle Scholar
  • 28 Blumenfeld AM, Stark RJ, Freeman MC, Orejudos A, Manack Adams A. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain 2018; 19 (01) 13
    CrossrefPubMedGoogle Scholar