Abstract
Objectives: The objective of this study was to analyze pediatric and adolescent chronic daily migraine response rates to modified doses of onabotulinumtoxinA.
Background: Chronic migraine occurs in about three percent of pediatric headaches. Some children and adolescents are intractable to two or more preventive medications. OnabotulinumtoxinA, 155-200 units every three months was approved by the US Food and Drug Administration for the use of chronic migraine in adults in 2010. Data on effectiveness and tolerability in the pediatric population is very limited. Standard dosing is not established for children.
Methods: A retrospective chart review of forty-four patients’ between 11 and 21 years of age who had 15 or more headache days a month and had been intractable to at least two different prevention medication treatments for chronic daily headache prior to receiving OnabotulinumtoxinA . There were 35 female patients and 9 male patients. Those who received onabotulinumtoxinA for treatment of chronic migraine in a pediatric headache center from February of 2014 to March of 2016 were analyzed. OnabotulinumtoxinA is offered to any pediatric or adolescent patient coming to the clinic for chronic migraine if they fail two or more preventive medications. Dosing was based on location of pain and tolerance of the procedure. Injection sites were outlined based on adult standard dosing suggestions. The review analyzed age, sex, diagnosis, location of pain reported, doses of onabotulinumtoxinA tried, quantity of injection sets, and response to treatment.
Results: Seventy percent of this population decreased their headache frequency and/or intensity by at least fifty percent. Forty-eight percent had less than two headaches a month. Ninety four percent of those that responded positively did so with less than one hundred and ten units of onabotulinumtoxinA.
Conclusions: This suggests that “less is more” in the pediatric and adolescent dosing of onabotulinumtoxinA for treatment of chronic daily migraine.
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