In this post, I would like to share some information we are publishing soon, a case study related to headache, autism spectrum disorder (ASD), and self injurious behavior. In this population, anything that can reduce this kind of behavior would be a welcome addition to the care of these often challenging patients.
We know that headache/migraine is very common in the general pediatric population, one of the most frequent chief complaints in the office. Migraine very often develops during childhood and adolescence. It also develops across the spectrum of development, and affects those of all abilities. So it would seem likely that migraine as well as other pain disorders would occur in some of those with intellectual disability, including autism spectrum disorder. As communication can often be challenging in this population, the pain experienced might be expressed physically and observed by family and others as self-injurious behaviors. Any treatment that would reduce this behavior and decrease suffering would be welcome. We took a novel approach using the Botox for chronic migraine protocol to reduce their self injurious behavior.
We have 2 patients in our practice with developmental delay (ASD, intellectual disability), chronic head pain including atypical face pain, and have self injurious behavior (head banging or hitting) in response to the pain. While they were different in presentation, the behavior in response to head pain was the same. As you can imagine, this self injurious behavior was very distressing to families and the patient.
After trying numerous medications, with unacceptable side effects and limited benefits, we wondered about trying the Botox protocol for chronic migraine with these teens. The families were anxious for any treatment options that would relieve the suffering. We were able to obtain insurance approval and moved forward with the initiative.
These young people were experiencing near-daily migraine/pain episodes prior to Botox. We hoped after several treatments, done 12 weeks apart, that this frequency would be reduced. They both were able to tolerate the procedure with behavioral and emotional supports, no need for sedation.
After 2-3 Botox for chronic migraine procedures, spaced 12 weeks apart, both teens experienced a significant reduction in migraine/pain frequency to no more the 1-2 times/month or even less. They both did have some wear-off in the last 2 weeks prior to the next procedure (common for everyone), but did not return to the near-daily frequency. As a result of reduction in migraine, there was a concurrent significant reduction in self-injurious behavior. This was the best possible response! These 2 young people continue under care using Botox and are doing well from a migraine/pain perspective.
Sometimes you can apply a standard protocol to a less than standard situation and achieve a positive response. It is gratifying to see these youngsters in less pain and distress and to remove a source of stress for the families.
HeadFirst PNP 