Onabotulinumtoxin A Is an Effective Preventative Treatment of Chronic and Daily Pediatric Migraine

Despite high efficacy and favorable safety profile in adults, Onabotulinumtoxin A (ONA) injections have not been Food and Drug Administration approved for pediatric migraine due to a lack of consistent data in children with chronic headaches.

We prospectively surveyed 45 patients between 12 and 22 years of age with chronic migraine receiving ONA treatments using the Phase II Research Evaluating Migraine Prophylaxis Therapy protocol in our pediatric headache clinic. Subgroup analysis was performed on patients with daily chronic migraine. Headache frequency, pain scores, and disability were assessed at baseline and 6 weeks after each treatment.

Forty-five patients were included for analysis; median age was 17 years, and 36/45 (80%) were female. Twelve out of forty-five (27%) patients had a greater than 50% reduction in headache days after one treatment (P < 0.005). Of the patients with available data following two treatments, 8/24 (33%) patients had a greater than 50% decrease in headache days (P = 0.004). In the subset of patients with daily chronic migraine, 6/27 (22%) patients had a greater than 50% reduction in headache days after the first treatment (P = 0.016). Mean headache disability as measured by the Headache Impact Test decreased after the first four treatments in the entire cohort and after the second and third treatments in the subset of patients with chronic daily migraine.

These results suggest that ONA is effective in decreasing headache frequency and disability in pediatric patients with both chronic migraine and daily chronic migraine, which may improve quality of life.