Botulinum toxin in migraine prophylaxis

“…Several patients in two groups of this study injected with BTX-A had transient unilateral upper eyelid ptosis and injection site pain and recovered quickly without any treatment, confirming the tolerability of BTX-A as reported by other studies (31). Other agents used in the prophylaxis of migraine cause side effects such as fatigue, dizziness, reduced concentration, loss of appetite, weight gain, hair loss, and changes in libido (42). However, BTX-A has not been reported to bring such side effects.…”

Section: Discussionmentioning

confidence: 99%

Botulinum Toxin Type A Therapy in Migraine: Preclinical and Clinical Trials

Shao¹,

Zhang²,

Zhao³

et al. 2013

Iran Red Crescent Med J

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BackgroundBotulinum toxin type A (BTX-A) has been reported to be effective for the therapy for migraine. The purpose of this study was to investigate the effect of BTX-A on the immunoreactive levels of calcitonin gene-related peptide (CGRP) and substance P (SP) in the jugular plasma and medulla oblongata of migraine in rats induced by nitroglycerin (NTG), and then to evaluate and compare the effectiveness of fixed (muscle)-sites and acupoint-sites injection of BTX-A for migraine therapy of patients in a randomly controlled trial extending over four months.Materials and MethodsRats with NTG-induced migraine were subcutaneously injected with vehicle or BTX-A (5 U/kg or 10 U/kg bodyweight). CGRP- and SP-like immunoreactivity (CGRP-LI and SP-LI) were determined by radioimmunoassay. In clinical trials, sixty patients respectively received BTX-A (2.5 U each site, 25 U per patient) at fixed-sites (group F, n = 30) including occipitofrontalis, corrugator supercili, temporalis and trapezius or at acupoint-sites (group A, n = 30) including EX-HN3, EX-HN5, GV20, GB8, GB20 and BL10.ResultsLocal BTX-A injection suppressed NTG-induced CGRP-LI and SP-LI levels in jugular plasma and oblongata. BTX-A injection for both groups with migraine significantly reduced the attack frequency, intensity, duration and associated symptoms. The efficacy of BTX-A for migraine in group A (93% improvement) was more significant than that in group F (83% improvement) (P < 0.01).ConclusionsThe evidence that BTX-A decreases NTG-induced CGRP-LI and SP-LI levels in trigeminovascular system suggests that BTX-A attenuates migraine by suppression of neuropeptide release. BTX-A injections for migraine at acupoint-sites and fixed-sites are effective. Acupoint-sites BTX-A administration shows more efficacy for migraine than fixed-sites application.

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“…patients with >15 attacks/month for >3 months); and patients in whom previous therapy has been ineffective or poorly tolerated. [22,39] …”

Section: New Treatmentsmentioning

confidence: 98%

The Effect of Migraine Prophylaxis on Migraine-Related Resource Use and Productivity

Láinez

2009

CNS Drugs

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In the US, it is estimated that up to 10% of men and 25% of women, particularly those aged 25-55 years, experience debilitating migraines, such that the condition presents an enormous economic burden for patients, health systems, employers and society. Migraine headache is a particularly prevalent condition associated with major reductions in patients' quality of life. From a payer perspective, the implementation of relevant programmes of migraine prophylaxis is highly desirable. Consistent evidence exists, from several randomized, controlled studies, of the efficacy of amitriptyline, divalproex sodium, propranolol, timolol and topiramate in migraine prophylaxis. Considering resource utilization, various studies suggest that migraine prophylaxis with antiepileptics, antidepressants, beta-blockers or calcium channel antagonists markedly reduces triptan use and visits to physician offices and emergency departments (EDs), without compromising quality of care or treatment outcomes. Over recent years, the effects of topiramate in reducing resource utilization in patients with migraine have been relatively widely studied. In US claims database analyses involving >4000 patients with migraine, topiramate significantly reduced triptan use by up to 20% in the 12-month period after starting treatment. Reductions were also noted in the numbers of ED visits, diagnostic procedures, hospital admissions and migraine-related hospitalization days. These long-term benefits of topiramate manifested without any increase in overall headache-related costs. Furthermore, in detailed modelling analyses based on UK and US data, topiramate-induced savings in acute medical services were estimated to offset about one-quarter of the monthly per patient cost of the topiramate regimen, which was shown to be a dominant cost-effective intervention relative to no preventive therapy: cost-effectiveness ratios were calculated as pound 5728 per quality-adjusted life-year (QALY) [2005 costings] and $US10 888 per QALY (2002 costings), respectively. Overall, there is a need to improve quality of care in migraine, and prophylactic therapy appears to be an effective option, particularly with respect to decreasing resource use and improving productivity. For both health-plan payers and employers, topiramate appears to be a cost-effective intervention for preventing migraine.

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Botulinum toxin in migraine prophylaxis

Cited by 30 publications

References 38 publications

Long-term benefits of botulinum toxin type A (BOTOX) in chronic daily headache: a five-year long experience

Long-term benefits of botulinum toxin type A (BOTOX) in chronic daily headache: a five-year long experience

Botulinum Toxin Type A Therapy in Migraine: Preclinical and Clinical Trials

The Effect of Migraine Prophylaxis on Migraine-Related Resource Use and Productivity

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