Recently, in the Journal of the American Medical Association there was a review and meta-analysis on the benefits of onabotulinumtoxinA (Botox A), or rather a devalued opinion of it’s benefits for chronic migraine (CM).  As a therapy for migraine, the authors concluded that “…[for CM] the association of botulinum toxin A with clinical benefit was small.”

John Rothrock MD and Editor-in Chief of Headache: The Journal of Head and Face Pain puts forward the case that Botox A may not indicate clear advantages for tension-type headache or episodic migraine (EM) but that may not be the case regarding Botox A and CM.  Dr. Rothrock points out that the frequency of headache days showed a statistical significant benefit in favor of Botox A.  After only 2 treatments, almost 50% of subjects experienced a 50% or greater reduction in headache frequency.  This result implies a remission of CM to episodic migraine (EM) “… This result is of tremendous clinical relevance to both those who suffer from CM and those who endeavor to treat them, and the response rates compare quite favorably to what has been recorded from studies involving administration of oral agents for the prophylaxis of EM or CM.”

“CM is more disabling and exacts higher direct and indirect medical costs than EM.  Administration of Botox A for CM reduces migraine-related direct medical costs and improves quality of life.  What precisely is it, then, that JAMA and the authors of the index article desire?  Sure, all of us yearn for a “full glass” therapy – cheap and invariably effective – but sometimes a “half-glass” is to be celebrated as well…. especially for a disorder as “new”, common, expensive, and lacking in therapeutic alternatives as CM.”

Dr. Rothrock also notes that studies involving open-label administration of Botox A for CM have produced similar occurrences of remission to EM… resulting in a large reduction in migraine-related healthcare resources.  Headache: The Journal of Head and Face Pain   June, 2012



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