Botox Injection AnabotulinumtoxinA For Chronic Migraine Headaches Prevention Approved By FDA

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Main Category: Headache / Migraine
Also Included In: Regulatory Affairs / Drug Approvals;  Pain / Anesthetics;  Neurology / Neuroscience
Article Date: 16 Oct 2010 - 9:00 PDT

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'Botox Injection AnabotulinumtoxinA For Chronic Migraine Headaches Prevention Approved By FDA'

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AnabotulinumtoxinA, a botox injection for people who experience migraine headaches on most days of the month - chronic migraine - has been approved in the USA by the Food and Drug Administration (FDA). According to the FDA, a migraine headache is a strong, pulsating pain in a specific area of the head, often accompanied by nausea, photophobia (sensitivity to light), sonophobia (sensitivity to sound), and sometimes vomiting. Women are three times more likely to suffer from migraines than men. Although most patients who get migraines do so intermittently, some develop disabling chronic migraine which is present for more than 50% of the days of each month, lasting four hours a day or longer.

The therapy has been approved as prophylactic (preventive) treatment.

Russell Katz, M.D., director of the Division of Neurology Products in the FDA's Center for Drug Evaluation and Research, said:

Chronic migraine is one of the most disabling forms of headache. Patients with chronic migraine experience a headache more than 14 days of the month. This condition can greatly affect family, work, and social life, so it is important to have a variety of effective treatment options available.


Multiple Botox injections, administered around the head and neck, have been found to be effective in dulling chronic migraine symptoms. However, it is not effective for patients with episodic migraine (occurring less than 14 days per month), neither is it effective for other non-migraine types of headaches. The FDA stresses that patients should talk to their doctors about what is the best treatment for them, and whether Botox is the right therapy.

Botox and Botox Cosmetic - the brand names for OnabotulinumtoxinA - are manufactured by Allergan Inc., Irvine California. There is a boxed warning explaining that Botox's effects can spread to other parts of the body and cause botulism-type symptoms, which may include breathing and swallowing difficulties; these can sometimes be serious and life-threatening.

The FDA adds that there are no reports of serious cases of the toxic effect of Botox spreading to other parts of the body when it has been administered with the right dosage for chronic migraine, excessive sweating under the arms, strabismus, or the improvement of frown lines.

According to Allergan, when injected at the indicated dosages in the specific areas in the head and neck, Botox should produce results that last up to three months, depending on the individual patients.

About 3.2 million individuals in the USA are thought to suffer from chronic migraine. According to the World Health Organization (WHO), chronic migraine is the 19th most disabling disease there is; severe migraine has been described by experts as more disabling than angina, rheumatoid arthritis, blindness and paraplegia.

Patients with chronic migraine are significantly more likely to also suffer from depression and anxiety. The condition can be influenced by sleeping habits, diet, overusing acute pain relieving medications, and stress.

Scott Whitcup, M.D., Allergan's Executive Vice President, Research and Development and Chief Scientific Officer, said:

Chronic Migraine is a debilitating but under-recognized neurological condition. Often times, Chronic Migraine patients mistakenly self-diagnose their symptoms as headaches or infrequent migraine and treat them with drugs that provide rapid, but temporary, relief rather than seeking an evaluation, diagnosis and treatment from a qualified headache specialist. With BOTOX(R) approved by the FDA for Chronic Migraine patients, there is now a new preventive treatment option to reduce the days and hours spent in pain as a result of this condition.


Source: Allergan, FDA

Written by Christian Nordqvist

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Visitor Opinions (latest shown first)

A Chronic Migraine Sufferer and Drug Expert

posted by Dr. Kate Adams, PharmD on 19 Dec 2010 at 6:09 pm

I have a unique perspective as both a PharmD and the sufferer of daily chronic migraine. I have used Botox before cosmetically with no side effect. These early studies are, of course, premature in there findings, but as healthcare professionals, don't we all know that drugs get "grandfathered" in for additional FDA approval much quicker once the drug is deemed safe initially? Anybody who suffers from this illness and has tried every medication and therapy available to no avail, is ready for another alternative.

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Botox for chronic migraines

posted by Tracy on 15 Dec 2010 at 8:33 pm

I am happy to hear that this was approved but never knew about it till today when my pain management doctor suggested it. I have been diagnosed with chronic migraines and have them most days of the month and of course some are worse than others, I have taken every medicine known to man for migraines and nothing has helped. I am looking forward to getting this approved by my insurance company.

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a neurologist's opinion - botox for migraine

posted by Dr. Howard Weiss on 16 Oct 2010 at 12:01 pm

I am very happy that the FDA has appoved botox for chronic migraine. Headache specialists have known for years that botox was quite helpful in reducing the frequency and severity of migraine for many patients who experience very frequent attacks. Unfortunately it is not a panacea and is not helpful in every patient.
The injections are safe and without the unpleasant side effects that many patients experience when taking daily migraine preventive medications such as topamax or depakote.

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Why did the FDA approve this for migraine-THIS IS CRAZY?

posted by Dr. A F on 16 Oct 2010 at 10:19 am

I have reviewed the data and have no idea why has the FDA approved Botox for chronic migraine? The incremental benefits of this drug (7.8 less days) over a sugar injection (6.4 less days), only adds 1.4 days of benefits over 24 weeks. There are 31 injections administered in 7 areas of the head at a cost of $ 2000.

In 123 patient PREEMPT studies, adverse reactions reported by greater than two percent of patients treated with BOTOX® and more frequent than in patients treated with placebo included headache, migraine and facial paresis, eyelid ptosis (eyelid drooping), bronchitis, musculoskeletal and connective tissue disorders, including neck pain, musculoskeletal stiffness, muscular weakness, myalgia (muscle pain), musculoskeletal pain and muscle spasms, injection site pain and hypertension.

The cost, benefits and risk/benefit ratio all of it off balance. I hope the FDA re-considers its decision. This by far is the most irrational decision by the FDA.

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