Greetings! I have been absent for a bit, dealing with a health issue, but now I am back and feeling great.
I wanted to report back some findings, which we are submitting for publication, about using Onabotulinumtoxin A (BTX-A or Botox) for chronic migraine in teens under age 18. We have been able to get a number of these procedures approved through insurance. We wanted to add to the literature supporting this practice as safe and effective, in the hopes that insurance companies will become more willing to cover this procedure for their teenagers with chronic migraine.
Migraine and headache are some of the most common complaints seen in primary care for adults and pediatrics. The burden on families is tremendous, with lost work/school time. There are few medications that are both effective and without significant side effects for children and teens with chronic migraine. We reviewed safety and efficacy for those patients under age 18 we treated with BTX-A for chronic migraine. It has been approved by the FDA for those over age 18 since the 2000s.
We looked at the clinical data for adolescents between 13-17 years of age, who underwent 2 BTX-A treatments for their chronic migraine (defined as 15+ migraine days/month). Examined data included the frequency, duration, and severity of headache pain in comparison to the baseline data recorded prior to beginning BTX-A treatment.
Results: In a sample of 32 patients, BTX-A was a safe and effective intervention. Following BTX-A, headache days were reduced by nearly 7 days per month. There were 6 patients who were identified as non-responders. While pain severity remained moderate, a statistically significant decrease in quantified pain ratings was reported. Some patients did experience side effects, but they were not beyond the expected scope or severity of known post-procedure effects, and were transient or temporary.
Discussion: The purpose of this study was to demonstrate the safety and efficacy of adolescents under age 18 receiving BTX-A for chronic migraine. It also adds to the literature supporting its use for those under age 18. Considering the limited medications and interventions available to this population, this treatment should be more readily available to children and adolescents.
One of the goals of effective treatment of migraine in pediatrics is the early intervention and/or prevention of chronic migraine. Allowing them to receive the safe and effective BTX-A injections will lessen significant impact of chronic migraine on their physical, emotional and mental health. It is hoped that using this treatment for those who are suffering from chronic migraine can return them to an episodic migraine pattern, which would certainly reduce their suffering and the impact on the patient and family.
While there is a lack of programs or providers willing or able to administer BTX-A treatment to adolescents, obtaining insurance approval remains the major barrier. Many adolescents with migraine may suffer needlessly, when a likely reduction in migraine is possible for them, with minimal distress, following BTX-A treatments. There are new medications available now for the prevention and treatment of migraine, presenting great promise. None of these is approved for those younger than age 18. Another barrier for this population.
From a clinician’s point of view, being able to offer advanced care to patients and their families who are struggling is a gift. There have been so many lives changed for the better because of access to this care. A reduction in migraine means a reduction is school absences, the ability to achieve to their potential academically, to participate in sports, music and theater, meaningful community service and work. An unexpected effect for many patients is that their rescue regimen became effective again, which relieves a significant anxiety for many. The patients do not really enjoy their BTX-A procedures, but they do not miss their appointments because it really works for them.
For pediatric headache providers, the availability and accessibility of BTX-A for their teens with chronic migraine is crucial to providing safe and effective care. Breaking the barrier around insurance approval is the key to our patient’s success.