Introduction Chronic
migraine is particularly devastating. It affects school work, extracurricular activities, and quality of life, including relationships with other family members, and can also influence the mental health of both the migraineurs and family members. According to the International Classification of
Headache Disorders, 3rd edition (ICHD-3), chronic
migraine is defined as 15 or more
headache days per month for greater than three months, where at least on eight days per month, there are features of
migraine headache. Although
botulinum toxin type A (BoNTA) has been proven effective for treating chronic
migraine in adults, little literature exists about its use in children. Here, we present the treatment response in children with chronic
migraines treated with BoNTA at our institutions Duke and State University of New York (SUNY) Upstate. Method A retrospective analysis of 30 adolescent migraineurs who met ICHD-3 criteria for chronic
migraine were treated with BoNTA injection according to the standardized adult protocol. Descriptive statistics and paired t-tests were performed. A total of 185 units of
botulinum toxin were injected intramuscularly per patient, as in addition to the standard 31 sites for a total of 155 units, an additional 30 units were given in areas that were felt to provide further benefit. Results Participants (
n=30) were 16.5 ± 1.83 years old. The
headaches were precipitated by
trauma in seven cases. All had failed standard
pharmacotherapy, including
amitriptyline and
topiramate. An average of 2.47 ± 1.6 BoNTA injection cycles was performed.
Migraine severity decreased significantly from 7.47 ± 1.89 on a 10-point scale to 4.34 ± 3.02 (p<.001). Additionally,
headache frequency improved from 24.4 ± 7.49 painful days per month to 14.8 ± 12.52 painful days per month (p<.001). One patient developed
nausea related to
injections; all others tolerated it well, with no side effects. Discussion BoNTA injection was a safe and effective
therapy for chronic
migraine in our cohort of children recalcitrant to medical
therapy. Further research with multi-centered, double-blinded, randomized, placebo-controlled trials is warranted to evaluate the long-term safety and efficacy in this population.