OnabotulinumtoxinA as a Treatment for Chronic Migraine

Carrie Dougherty, MD, FAHS, shares who is a suitable candidate and how providers can help patients access care

Dr. Carrie Dougherty, Assistant Professor in the Department of Neurology and the Program Director of Headache Medicine Fellowship at MedStar Georgetown University Hospital, recently spoke on onabotulinumtoxinA as a potential treatment for patients with chronic migraine. Watch the full interview from the 2018 Scottsdale Headache Symposium here:

OnabotA is different from other types of preventive treatments: It is a procedure that is administered every 12 weeks as an ongoing prevention method. The procedure is comprised of 31 injections located in the forehead, temples, back of the head, and the neck that target the nerves that are typically activated during migraine..

“Botox should be a consideration for anyone with chronic migraine who has a history of preventive failure,” says Dr. Dougherty. That includes a patient who has experienced intolerable side effects to previous treatments or general ineffectiveness of treatments. OnabotA can also be beneficial for patients who are tired of trialing oral preventives and prefer a more locally targeted treatment.

Patients may begin to experience modest relief after the first 12 weeks following an OnabotulinumtoxinA treatment. Dr. Dougherty says, “The initial result might just be reduced severity. Patients will say, ‘I noticed that my abortive medication works better. I noticed that I’m not missing as much work, but I still have the same frequency when I do the numbers in my headache diary.’”

Research shows that patients can see a significant reduction in migraine attacks after the second and third rounds of injections, each round separated by 12 weeks. If after the third round, patients do not see any change in the frequency or severity of their headaches, then it may be time to consider an adjunctive medication or an alternative treatment option.

As for administering the treatment to patients, Dr. Dougherty says, “OnabotA injections for migraine is like paint by numbers. Anybody who is comfortable administering injections is going to be a qualified provider as long as he or she is trained on the specific treatment paradigm for chronic migraine.”