Botox Tops Topiramate for Chronic Migraine Prevention

July 16, 2018

SAN FRANCISCO —  OnabotulinumtoxinA (Botox, Allergan) treatment is more effective, is better tolerated, and has greater functional improvement in the prevention of chronic migraine compared with the anticonvulsant topiramate, new research suggests.

The findings were presented here at the American Headache Society (AHS) Annual Meeting 2018.

The AAN guidelines state:

•OnabotulinumtoxinA is established as effective and should be offered to increase headache-free days (Level A evidence) and is probably effective and should be considered to improve health-related quality of life (Level B) in chronic migraine.

•OnabotulinumtoxinA is established as ineffective and should not be offered for episodic migraine (Level A) and is probably ineffective for chronic tension-type headaches (Level B).

Safety: Investigators reported no new safety signals and that about two thirds of patients were satisfied. In topiramate group there was much higher discontinuation rate due to side effects and lower tolerability rate.

Conflict of Interest: It is important to note that the trial was sponsored by Allergan, the company that manufactures botulinum.

Treatment arms: In the current study, patients received onabotulinumtoxinA injection of 155 U in three cycles 12 weeks apart or topiramate titrated up to the approved dose over the first 12 weeks, and then maintained at 50 to 100 mg/day up to week 36.

Depression symptoms: OnabotulinumtoxinA treatment was associated with significant improvements in depression symptoms compared with topiramate at week 36.

Cognitive results: The investigators also found toxin therapy associated with a small increase in cognitive scores, suggesting better cognition/verbal fluency. In contrast, cognitive scores decreased in the topiramate group as early as week 12 suggesting cognitive changes occurred early in treatment with topiramate.

Please book your appointments with Howden Medical Clinic as we offer Botox treatment for chronic migraine which can be covered by most private insurances.