Botox Effective for Pediatric Refractory Migraine

As the treatment is currently used off-label, optimal dosing has not yet been established.

VANCOUVER – OnabotulinumtoxinA has been approved for the treatment of chronic daily headache in adults in a dose range of 155 to 200 units. As the treatment is currently used off-label in pediatric and adolescent patients, an optimal dose has not yet been established.

In an effort to identify an efficacious dose, Tara Pezzuto, APRN, from Nemours Alfred I duPont Hospital For Children and colleagues conducted a retrospective chart review of 42 pediatric and adolescent patients who received treatment with Botox™ from February 2014 to March 2016 after failing to respond to at least 3 preventive medications including topiramate, amitriptyline, divalproex, propranolol, and cyproheptadine.

The results were reported at the 2016 Child Neurology Society Annual Meeting in Vancouver, British Columbia, October 26-29, 2016.

Of the 42 patients (35 female, 8 male; age range 11 to 18 years) included in the study, 47% had chronic migraine without aura and 53% had chronic migraine with aura. Sixty-six percent responded to a dose <110 units, while 16% responded to a dose <75 units and 16% responded to a dose of <50 units. In all, 71% of patients reported a significant improvement in the intensity and frequency of migraine.

Overall, treatment with onabotulinumtoxinA was tolerated well, with patients reporting only soreness at the injection site as an adverse event.

The results suggest that prospective studies should be conducted in order to establish an optimal dose range for the pediatric and adolescent population.

For more coverage of CNS 2016, go here.


Pezzuto T, Beyderman L, Chugani D, Xie L. Is less more? Pediatric intractable migraine and Botox treatment. Presented at: Child Neurology Society 2016 Annual Meeting. October 26-29, 2016; Vancouver, BC. Abstract 8.  

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