OnabotulinumtoxinA successfully used as migraine prophylaxis during pregnancy: a case report

Botulinum toxin (btx) received U.S. Food and Drug Administration approval for migraine treatment in 2010 with a pregnancy category C. There are minimal reports of its usage in pregnancy with no adverse effects; however, there are no reported cases of usage in a known pregnancy for the successful treatment of migraines. We present a patient with a history of 4 to 5 migraines per week refractory to treatment who was subsequently controlled with btx. She initially stopped injections, however, her migraines increased to 5 to 6 per week while using standard medications for migraine treatment in pregnancy. She requested btx while 18 weeks pregnant after which she had full resolution of her migraines. She gave birth to a healthy full-term girl with no neuromuscular or developmental concerns spanning the first 6.5 years of her life, the longest reported follow-up of an infant whose mother received btx while pregnant. This is the first reported case in the literature of a patient requesting btx injections for migraine treatment while knowingly pregnant. The foundation of a btx pregnancy registry, similar to those used for antiepileptics, would be greatly beneficial to gather more safety data in regard to its further usage during pregnancy.