Review shows Botox (Allergan) offers modest benefit for chronic Migraine and daily headaches

A review of previous studies of Botox (onabotulinumtoxin A), from Allergan, finds a small to modest benefit for patients with chronic Migraine headaches and chronic daily headaches, although Botox injections were not associated with greater benefit than placebo for preventing episodic Migraine or chronic tension-type headaches. Pooled analyses of the data suggested that Botox was associated with fewer headaches per month among patients with chronic daily headaches (1,115 patients, -2.06 headaches per month) and among patients with chronic Migraine headaches (1,508 patients, -2.30 headaches per month). There was no significant association between use of Botox and reduction in the number of episodic Migraine (1,838 patients, 0.05 headaches per month) or chronic tension-type headaches (675 patients, -1.43 headaches per month). In the 4 trials that compared Botox with other treatment modalities, Botox was not associated with reduction in headache frequency compared with topiramate (1.4 headaches per month) or amitriptyline (2.1 headaches per month) for prophylaxis against chronic migraine headaches. Clinical benefit appears small: Botox was associated with a reduction in the number of headaches per month from 19.5 to 17.2 for chronic Migraine and from 17.5 to 15.4 for chronic daily headaches. The study by Jeffrey L. Jackson of the Medical College of Wisconsin, Milwaukee and colleagues is publsihed in the April 25 issue of JAMA.