Botulinum toxin for the treatment of photophobia in chronic migraine patients

Abstract

Purpose : Botulinum toxin is an effective treatment to reduce the frequency of headaches in chronic migraine sufferers but its effects on photophobia are less clear. We performed a retrospective clinical study to evaluate the efficacy of botulinum toxin on photophobia in chronic migraine sufferers and assessed factors predictive of a positive response to treatment.

Methods : We reviewed medical records of 30 patients who received botulinum toxin for the treatment chronic migraine and had photophobia data available in the record. All patients were seen at the Miami Veterans Affairs Hospital between August 22, 2016 and November 28, 2016. Information collected included: demographics, co-morbidities, current medications, migraine characteristics, and clinical response to botulinum toxin. Self-reported photophobic severity was evaluated using an 11-point numerical rating scaled anchored at “0” for no photophobia and “10” for the worst photophobia imaginable. Clinical response to botulinum injection was assessed using self-reported improvement ratings as either “worse”, “no change”, “a little better”, “better” or “much better.”

Results : Of the 30 patients reviewed during this study, 17 (57%) were male with a mean age of 45.3 years standard deviation (SD 11.1). All patients reported photophobia associated with migraine (mean photophobia severity score 7.7 SD 1.8) and all had undergone at least 1 botulinum injection (mean total number of injections 8.9 SD 7.3). 28 patients (93.3%) received adjuvant therapy in addition to botulinum injections with triptans being the most common (n=13; 43.4%). 17 patients (61%) reported at least some improvement in photophobia after injection (4 a little better, 6 better, and 7 much better). Mean ages of respondents reporting “no change”, “a little better”, “better” and “much better” were 37.7 SD 7.3 years, 44.8 SD 13.0 years, 50.3 SD 7.9 years and 50.3 SD 12.1 years, respectively (p=0.04) demonstrating that older age was significantly and positively associated with improvement in photophobia after botulinum injection.

Conclusions : All patients receiving botulinum toxin injections for chronic migraine reported photophobia, with the majority rating its intensity as moderate to severe. Some, but not all patients, reported improvement in photophobia after injection, with older individuals more likely to report improvement in photophobia.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.