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R. Singh, A. Singh, R. Burnstine; Botulinum Toxin A Therapy for Chronic Migraine in the Pediatric Population – A Pilot Study . Invest. Ophthalmol. Vis. Sci. 2006;47(13):788.
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Chronic migraine is a common ailment affecting an estimated 45 million people in the United States. Although there are many treatments for the prevention of migraines, there are still many individuals for which there is not an effective cure. We see daily consults for headache in our pediatric ophthalmology clinic. Although there have been several studies evaluating the benefit of Botox injections for migraines in adults, literature search on Pub Med did not reveal any pediatric studies. In this study the goal was to undergo a pilot study to evaluate the efficacy of Botulinum toxin type A therapy in pediatric migraine sufferers and to provide the basis for a future more extensive study.
In this prospective case series we examined seventeen consecutive patients (age 10–18) between January 2003 and September 2004. Patients who met criteria for migraines that were refractive to traditional treatment, were referred from the Department of Neurology at Children’s Hospital Medical Center of Akron. A pre–treatment questionnaire was completed consisting of severity/number/duration of migraines, and number of school days missed per month. Patients were then offered injections of Botox A and were followed up, by telephone or office visit, at 1 week, 1 month, and 2 months post injection to determine if frequency and intensity of headaches were reduced.
Out of the 17 referred patients, 1 refused Botox injection. 6 patients did not complete the 2 month follow up. In the remaining 10 patients, nine patients experienced a decrease in number of migraines after injection. Overall, there was a trend towards reduction in number and intensity of headaches. The average number of headaches per month decreased from 18.6 pre injection to 9.3 per month at 1 week, 7.9 at 1 month, and 7.4 at 2 months post injection. There were no reported adverse events.
Our results show that Botox may have a role in the treatment of pediatric migraine. Although the results were not statistically significant due to large standard deviation, there was a trend towards improvement post injection. This was evidenced by a decrease in number and intensity of migraines post injection as well as a subjective improvement in quality of life. As this was a preliminary study, limits include small sample size, placebo bias and report bias. However, with a trend towards improvement, we feel that a second study with a larger sample size and other objective measures would be valuable and statistically significant. A study with these factors in mind is currently in its preliminary stages.
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