Botulinum Therapy for Migraine
About 15% of adults have migraine, and it is ranked as the 7th most common disease among all diseases worldwide.
One type of migraine, chronic migraine, is defined as 15 or more days of headache per month.Incidental migraine is defined as a headache that lasts less than 15 days per month.
Botulinum toxin type A, which was being tested in this study, is approved in some countries for the treatment of chronic migraine.
This study was conducted to evaluate the efficacy of botulinum toxin type A versus placebo in preventing or reducing the frequency of chronic or incident migraine in adults. The purpose of this study is to evaluate the effect of botulinum toxin versus placebo or active treatment on preventing or reducing the frequency of chronic or incident migraine in adults.
The study included
The study included 4,190 patients from 28 trials.
Some included three injections over a three-month period between treatments.
Most of the studies were small. Most trials were small, less than 50 patients per trial group.
Botulinum toxin and placebo
Three trials compared botulinum toxin and placebo.
Botulinum toxin may reduce the number of migraine days per month by 3.1 days.
(95% confidence interval (CI) -4.7 to -1.4, 4 trials, 1497 participants, low quality evidence)
In one trial (N = 418) of incident migraine.
The results showed no difference between the groups. (P = 0.49).
Chronic migraine reduced the number of headache days per month by 1.9 days.
Chronic migraine reduced headache days by 1.9 days per month (95% CI -2.7 to -1.0, 2 trials, 1384 participants, high quality evidence).
There was a difference in the number of migraine attacks between those with chronic symptoms and those with temporary migraine.
No evidence of a difference in the number of migraine attacks between people with chronic and temporary migraine.No evidence of a difference in the number of migraine attacks between those with chronic symptoms and those with temporary migraine (6 studies, N = 2004, P = .30, low quality evidence)
In the botulinum toxin group, 60 of every 100 participants experienced an adverse event.Adverse events occurred in 60 of every 100 participants in the botulinum toxin group and 47 in the placebo group.
Botulinum toxin vs. other treatments
Three trials compared botulinum toxin with alternative oral prophylaxis.
Meta-analysis of days of pain attacks was not possible due to insufficient data.
There was no difference in the risk of adverse events between botulinum toxin and oral treatment.(2 trials, N = 114, very low quality evidence)
Reviewer's comment.
In chronic migraine, botulinum toxin type A can reduce migraine days by 2 days per month compared to placebo treatment. Non-serious adverse events were probably experienced by 60/100 participants in the treatment group, compared to 47/100 in the placebo group. For people with incident migraine, we remain uncertain whether this treatment is effective because the quality of this limited evidence is very low. Better reporting of outcome measures in published trials would provide a more complete evidence base from which to draw conclusions.
Flock CP, Tomlinson CL, Rick C, Cotton WJ, Edwards J, Ives N, Clark CE, Sinclair A. Botulinum toxin for migraine prophylaxis in adults. Cochrane Database of Systematic Reviews 2018, No. 6. Number: CD011616. doi: 10.1002 / 14651858.CD011616.pub2.
In Japan, some facilities are offering Botox injections as a treatment for headaches and other symptoms.Why botulinum toxin? I was wondering. I read that botulinum toxin is associated with the release of toxic substances in the trigeminal nerve system and reduces inflammation.
In muscles, it inhibits acetylcholine receptors.
In other words, it seems to be one of the treatments to reduce pain.
They did describe significant data when compared to a placebo.
In the one comparing it to other treatments, no difference seems to have been found.Since this was a small study, it was stated that a larger study would be needed to draw firm conclusions, so I thought it would be a good idea to conduct the study after that.
