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Do all migraine sufferers benefit from botox treatment?
Onabotulinumtoxin A, often simply called botox, has been shown to provide relief from chronic migraines. Preventive use can significantly reduce the number of days of headache in most chronic migraine patients. However, not all of those affected respond equally well to treatment and so far this form of therapy has often been discontinued if no reduction in headache days seemed achievable. However, according to a study by scientists from University College London, the intensity of pain with onabotulinum toxin A can also be reduced in these patients.
According to the treatment guidelines of the German Society for Neurology (DGN) and the German Migraine and Headache Society (DMKG), onabotolinum toxin A is quite effective in preventing migraines, but the use of experienced neurologists should be reserved. The number of headache days can be significantly reduced by the treatment for many sufferers and in about half of the patients the migraine improves during the therapy to such an extent that no further botox injections are required, report the specialist societies. Other approaches to migraine prevention are also explained in detail in the treatment guidelines.
Botox therapy in the new treatment guidelines
Just a few weeks ago, the new treatment guidelines for migraines were presented, in which much more focus is placed on prevention and the use of onabotulinum toxin A in chronic migraines is also discussed. For this purpose, the active ingredient "has to be injected repeatedly at intervals of approx. 3 months in order to achieve a lasting and increasing effect", according to the guidelines. However, so-called non-responders exist in which the number of days of headache does not decrease.
Can non-responders also benefit?
In his study, the research team led by Manjit Matharu from the Institute of Neurology at University College London (UCL) used almost 1,700 migraine patients to investigate the extent to which the non-responders also experienced pain relief. So far, the treatment of non-responders has often been stopped because the number of days of headache does not decrease even with onabotulinum toxin A.
The clinical phase 3 study program of the UCL researchers to evaluate migraine prophylaxis therapy (PREEMPT) ran over a period of 24 weeks in which two treatment cycles took place. The subjects were randomly assigned to an active ingredient group (688 subjects) and a placebo group (696 subjects). This was followed by a further 32-week phase with three treatment cycles, in which all subjects took part.
Intensity of migraine headache determined
In parallel, the subjects kept a daily diary to record the intensity of the headache using a 4-point scale (from no pain to severe pain) and the clinical effects of the headache were recorded using questionnaires. In further analysis, the researchers examined whether the subset of patients who were non-responders for the first 24 weeks (patients with a headache frequency reduction of less than 50%) had nevertheless experienced a decrease in headache intensity through botox treatment.
Botox also relieves pain intensity
According to the researchers, the use of onabotulinum toxin A also showed a significant reduction in the number of days with severe headaches in the non-responders. In addition, the average headache intensity has decreased significantly. "These results suggest that even those patients with chronic migraines who are classified as non-responders based on an analysis of headache frequency experience a clinically meaningful relief from headache intensity after treatment with onabotulinum toxin A," the researchers concluded.
Other ways of preventing migraines
In addition to botox, the treatment guidelines of the DGN and DMKG also mention numerous other options for migraine prevention, with the beta blockers metoprolol and propranolol, the calcium antagonist flunarizine, the anticonvulsants topiramate and valproic acid and the tricyclic antidepressant amitriptyline being effective as drugs for migraine prophylaxis are. However, the guidelines explicitly refer to the possibilities of non-drug therapy. The preventive effects of endurance sports, measures to reduce stress and psychological pain therapy are particularly worth mentioning here. In the experts' opinion, these non-drug approaches should in future be much more in focus.
Naturopathy also knows some home remedies for migraines, which can not only provide relief for acute pain, but often also take a preventive approach. (fp)