Botox for migraines in children

Injections of onabotulinumtoxinA (Botox) are approved for the treatment of chronic migraine headaches in adults. Botox is also widely used off-label (not an FDA-approved use) for the treatment of migraines in children. We know that botulinum toxin is safe in children because another very similar form of botulinum toxin, abobotulinumtoxinA (Dysport) is approved for the treatment of cerebral palsy in children as young as 2. The youngest child with chronic migraines whom I treated with Botox was 8 years old.

Two groups of physicians presented results of their treatment of migraines in children with Botox at the recent annual scientific meeting of the American Headache Society held in San Francisco.

The first report, whose lead author was Ilya Bragin of St. Luke’s University Health Network describes positive results of Botox injections in 30 adolescents with chronic migraines. All 30 had to fail amitriptyline (Elavil) and topiramate (Topamax) to be eligible to receive Botox. Seven of of them had a history of a head trauma. The adult injection protocol of 155 units injected into 31 sites was followed. Both migraine frequency and severity improved with no reported side effects.

The second report from doctors in Delaware describes 44 children aged 11 to 20, who were treated with Botox for their chronic migraines. The dose ranged from 35 to 155 units, depending on pain location and child’s tolerance of injections. About 70% of children had at least a 50% improvement in their migraine frequency and severity. No child developed any side effects.

We tend to use the Delaware group’s approach in that we tailor the dose and the injection sites to each child, depending on pain location and weight of the child. And we also find that about 70% respond, which is the rate of improvement in our adult patients.