Migraine - Can a Botox therapy relieve discomfort

All migraine patients benefit from a Botox treatment?

Onabotulinum toxin A, often referred to simply as Botox, has been shown to provide relief in chronic migraine. Preventative use can significantly reduce the number of headache days in most chronic migraine patients. But not all sufferers respond equally well to the treatment and so far this form of therapy was often stopped if no reduction in headache days seemed attainable. However, according to a study by scientists from University College London, the intensity of pain with onabotulinum toxin A can also be reduced in these patients.

According to the treatment guidelines of the German Society of Neurology (DGN) and the German Migraine and Headache Society (DMKG) Onabotolinumtoxin A is quite effective in the prevention of migraine, but the use of experienced neurologists should be reserved. The number of headache days can be significantly reduced by the treatment of many sufferers and in about half of patients, the migraine during therapy improves so much that no further Botox injections are required more, report the professional associations. Other approaches to migraine prevention are also detailed in the treatment guidelines.

Chhronic migraine represents a significant burden for those affected, but there are opportunities for prevention. (Image: eggeeggjiew / fotolia.com)

Botox therapy in the new treatment guidelines

Only a few weeks ago, the new treatment guidelines for migraine were presented, in which much more focus is placed on prevention and also the use of onabotulinum toxin A in chronic migraine is discussed. For this, the drug must be "repeatedly injected at intervals of about 3 months to achieve a lasting and increasing effect," the guidance in the guidelines. However, there are so-called non-responders, in which the number of headache days does not decrease.

Can also benefit non-responders?

The research team led by Manjit Matharu from the Institute of Neurology at University College London (UCL) has investigated in nearly 1,700 migraine patients how the non-responders also experience pain relief. So far, non-responders often stop treatment because the number of headache days does not decrease, even on onabotulinum toxin A..

The Phase 3 clinical trial program of the UCL researchers evaluating migraine prophylactic therapy (PREEMPT) has been ongoing over a 24-week period involving two treatment cycles. Subjects were randomly assigned to a drug group (688 subjects) and a placebo group (696 subjects). This was followed by another 32-week phase with three treatment cycles, in which all subjects participated.

Intensity of migraine headache detected

At the same time, the subjects kept a daily diary to record the intensity of headache on a 4-point scale (from no pain to severe pain) and questionnaires recorded the clinical impact of the headache. In further analyzes, the researchers examined whether the subgroup of patients who had been non-responders in the first 24 weeks (patients with a reduction in headache daily frequency by less than 50%) had nevertheless experienced a decrease in headache intensity due to Botox treatment.

Botox also relieves pain intensity

According to the researchers, further use of onabotulinumtoxin A also showed a significant reduction in the number of days with severe headache among non-responders. In addition, the average headache intensity had decreased significantly. "These results suggest that even those patients with chronic migraine who are classified as non-responders on the basis of an analysis of headache frequency will experience clinically meaningful relief of headache severity after onabotulinum toxin A treatment," the researchers concluded.

Endurance sports is a proven effective method for non-drug migraine prevention. (Image: Wellnhofer Designs / fotolia.com)

Other ways of migraine prevention

In the treatment guidelines of the DGN and DMKG in addition to Botox numerous other possibilities of migraine prevention are mentioned, especially the beta-blocker metoprolol and propranolol, the calcium antagonist flunarizine, the anticonvulsant topiramate and valproic acid and the tricyclic antidepressant amitriptyline proven as drugs in migraine prophylaxis are. However, the guidelines expressly refer to the possibilities of non-drug therapy. Here are mainly the preventive effects of endurance sports, measures to reduce stress and psychological pain therapy to call. In the opinion of the experts, these non-drug-based approaches should focus much more strongly than before.

Naturopathy also knows some home remedies for migraine, which can not only provide relief in acute pain, but also often take a preventive approach. (Fp)