Findings published in Plastic and Reconstructive Surgery suggest that botulinum toxin type A injections are superior to placebo for reducing the frequency of chronic migraines after 3 months of treatment.
Researchers searched the MEDLINE, Embase, and Cochrane Library databases for double-blind, placebo-controlled trials that randomly assigned people with migraine to treatment with either botulinum toxin type A or placebo injected into the head and neck muscles. Studies were required to include ≥3 months of follow-up. Change in the number of headache episodes per month from study entry to 3-month follow-up comprised the primary outcome.
A total of 17 studies including 3646 patients with migraine were included in the final meta-analysis. In the pooled analysis, a tendency in favor of botulinum toxin was found over placebo at 3-month follow-up. There was a mean −0.23 difference in the change of migraine frequency (95% CI, −0.47 to 0.02; P =.08). The mean differential change in the reduction in frequency of chronic migraines was −1.56 (95% CI, −3.05 to −0.07; P =.04). Improvement in quality of life at 3 months was also higher in the botulinum toxin group vs the placebo group (P <.00001). A higher proportion of adverse events were found in the botulinum toxin type A group (risk ratio, 1.32; P =.002).
Limitations of the analysis include missing patient-level data as well as the lack of controlled trials that compared botulinum toxin with other prophylactic oral medications.
“Botulinum toxin type A is a safe and well-tolerated treatment that should be offered to patients with migraine,” the researchers concluded.
Bruloy E, Sinna R, Grolleau JL, Bout-Roumazeilles A, Berard E, Chaput B. Botulinum toxin versus placebo: a meta-analysis of prophylactic treatment for migraine. Plast Reconstr Surg. 2019;143(1):239-250.