OnabotulinumtoxinA in Pediatric Chronic Daily Headache

Chronic migraine occurs in about 3% of pediatric headaches. Many would be intractable to more than two preventive medications. OnabotulinumtoxinA has been approved by the US Food and Drug Administration for the use of chronic migraine in adults in 2010. Data on effectiveness and tolerability in the pediatric population are very limited. The study described in this article is a retrospective review of available data of all patients who received OnabotulinumtoxinA for chronic migraine in a large pediatric headache center from 2004 to 2010. Botox is recommended to any pediatric patient coming to the multidisciplinary clinic for chronic headache if they fail two or more preventive medications. This study showed a major change in the frequency of the headache with a statistical difference in the improvement of headache days per month. There was a 30-point drop in the pediatric disability scoring between first injection and follow-up injection with a change from severe disability to moderate disability.