Stephanie Mayor

Community Nursing

Botox

In a 2010 study, onabotulinymtoxinA (BOTOX) was used in the treatment for chronic

refractory migraines, focusing on the prevention of severe attacks. It is estimated that 2% of the

population meet the criteria to be diagnosed with Chronic Migraines. Migraines are a problem

that lead to significant decrease in quality of life, then leading to morbidity. Other secondary

problems such as digestion and neuropathy, occur due to the attempt to treat the severe and

undesirable side effects brought on by migraines. Prevention was a focus in this study in an

attempt to reduce the number of people becoming addicted to opiates to try and provide a relief

from the pain caused by the migraines.

Participants in this study were asking to keep a migraine diary detailing their experience

and specifically to include if the use of Botox stopped migraines and/or if it prevented them from

going to the Emergency Room to treat attacks. They were also asked to note the occurrence of

using triptans to treat their migraines. This study was targeted at those who did not receive relief

from the use of oral medications. In this case, pericranial injections of 100 U to 200 U every 3

months were given to the patients. 35 patients were included in this study, varying in age from

24-68 years. The number of sessions provided to the patients ranged from 2-15 with the mean

being 4.
 Before the use of Botox, the average amount of “headache days” per month was nearly

25. In addition, the number of days per month that were categorized as “severe, disabling

headaches” was 8.2 days. Prior to Botox use, the normal preventative treatments for chronic

migraines included the use of beta-blockers, amitriptyline, flunarizine, and neuromodulators.

According to this study, patients reported the use of previous preventative measures to not be

very effective and much preferred the use of Botox in comparison. A totally of 29 patients

involved in the study reported using oral triptans of at least 22 pills per month prior to the study.

In conclusion, 9 people responded with a reduction of headache days to be greater than

50%. Emergency visits related to migraines reduced from that of 3 to 0.4 per trimester, which is

an 83% reduction. Overall, severe attacks were reduced to an incidence of only 46%. The use of

subcutaneous triptan injections, reportedly used by 6 of the 35 participants, was reduced from 4.5

to 1.5 injections per month. Oral consumption was reduced by 50% from an average of 22 pills

to 11 pills per month. Complaints of the study were minimal, with a low occurrence of mild

adverse reactions.

Due to the findings of this study, I decided to research the FDA’s opinion of Botox to be

used in treating chronic migraines. I found an article published by the Journal of Pharmacology

and Pharmacotherapeutics in 2011 addressing just that. The FDA based their findings on a study

done by dermatologist Richard Glogau. In this study, Glogau found that 75% of his patients

suffering from migraines found relief of up to 6 months after receiving Botox injections into the

face and neck!

 The FDA has approved the use of Botox to treat chronic migraines that have an instance

of 14 days or less per month. The treatment is administered every 12 weeks in numerous spots

around the head and neck and dosages are 155 units. The medication is diluted amongst needles

to be administered in 31 different spots. According to the article, the exact dynamics behind why

Botox works is not known, however, it has been linked to diminishing muscle spasms and thus

weakening the intensity of the headaches.

Amongst the previous two articles, I noticed similarities in what can be interpreted as

either pros or cons. The main objective is that of the cost. According to the FDA, Botox is priced

at $525 per 100 U vial. This puts the 155 U dosage at $735. Based off your socioeconomic class,

this may seem to be an unrealistic option. However when considering the instance of how often

this amount is required, it may begin to allow for more comfort when encouraging such a

dramatic financial setback. Another pro is the possibility of cutting out other expenses, such as

oral analgesics and hospital visits when opting for this line of treatment. Cons include the

possibility of a treatment being more than the approved 155 units. In the first study, it was

documented that patients were receiving doses as high as 200 units and therefore, could bring the

price range on the side of $1000 or more.