Search Results for: OnabotulinumtoxinA

3 January 2023

Botox and Neck Pain?

James Treatments Botox, chronic migraine, neck pain, onabotulinumtoxinA, Toxins 0

It’s good to see researchers paying more attention to neck pain as a symptom of migraine. One example is a study being published this year in the journal Toxins.

In this case, the study focused on onabotulinumtoxinA treatment, commonly known under the brand name of Botox. Botox has become a well-known treatment for chronic migraine, although we still have a lot to learn about the best way to use it.

This study focused not only on headache pain, but also neck disability and pain. Researchers used the Neck Disability Index (NDI), a ten-question survey filled out by patients to measure just how much neck pain is affecting their lives (see this example). For example, do you have trouble driving because of the pain? Are you avoiding recreational activities? Is neck pain robbing you of sleep?

A single onabotulinumtoxinA session did significantly decrease neck pain and disability in the patients over the next three months. Significant disability due to neck pain became mild, and headache pain decreased as well.

The authors of the study noted that this could mean a significantly better quality of life. These were patients who, at the beginning, were significantly disabled by both headache and neck pain.

This was a short-term study, so the researchers would like to see if these improvements hold over a longer period of time, with further treatments.

Still, there are a couple of things that can be taken from this study. First, be aware of neck pain and stiffness, during and in-between your migraine attacks. This is a symptom which may be causing you a lot more trouble than you realize. Second, if you have chronic migraine and have considered Botox as a treatment, this might be a further reason to give it a try. Be sure to keep track of both your headache and migraine symptoms and your neck pain, and share your results with your doctor.

For more on this study, see the pdf here: OnabotulinumtoxinA Treatment in Chronic Migraine: Investigation of Its Effects on Disability, Headache and Neck Pain Intensity

21 July 2021

AEON Biopharma: Better than “Botox”?

James News, Treatments ABP-450, AEON Biopharma, Botox, botulinum toxin, cervical dystonia, clinical trials, onabotulinumtoxinA, prabotulinumtoxinA 0

By now, Botox has become a common treatment for migraine. But AEON Biopharma wants to create a similar but better treatment.

Botox is a brand name for injections made from botulinum toxin A, specifically onabotulinumtoxinA. Given by injection, it has been helpful as a migraine preventative.

In spite of calls for standardization, the fact is that we still have a lot to learn about how to best use botulinum for migraine. How many injections is best? Where should the injections be? How often? Is there a difference for different types of migraine?

Another type of botulinum toxin A is prabotulinumtoxinA (PRA). Like onabotulinumtoxinA (ONA), PRA is used to fight wrinkles. Different types of botulinum come from different sources and processing.

AEON wants to use their own special version of PRA to help prevent migraine. And they’re hoping that they can do it with fewer injections than the typical Botox treatment.

This new treatment is currently known as ABP-450. ABP-450 is entering into phase 2 trials in Australia, Canada, and the USA, so you can check out more information here if you’re interested in being involved. Both episodic and chronic migraine patients are invited.

ABP-450 is also being studied as a treatment for cervical dystonia, a painful condition involving neck spasms.

For more information, check out AEON’s official press release here: AEON Biopharma Initiates Enrollment in Phase 2 Trial of ABP-450 for the Preventive Treatment of Migraine

2 March 2021

Chronic Migraine + Daily Headache?

James Discoveries & Stats Botox, chronic migraine, daily headache, Neurology Magazine, onabotulinumtoxinA, Revista de Neurología 2

A recent review of migraine studies may have uncovered a hole in the research. Are people with chronic migraine and daily headache being overlooked?

Admittedly, it may be hard to exactly tell what’s going on when a patient simply has constant headache pain. Once you have chronic migraine, that’s an attack at least every other day. Who is to say that the headaches “in between” aren’t just migraine attacks “coming or going”?

But researchers for the Revista de Neurología (Neurology Magazine), a journal in Spain, discovered what may actually be a big problem with the research.

When a clinical trial starts for migraine, researchers are looking to be as precise and clear-cut as possible. They want people with migraine, or without it. And they want to know if it’s episodic or chronic. They don’t want people in mysterious in-between land. Which means that you’re not likely to even get into the study if you have migraine as well as some unspecified daily headache.

The researchers from Revista de Neurología 1.7 – 3.3% of migraine patients may fall into this category (in case you’re wondering, that’s a lot of people!). So, although current studies may benefit them, essentially these people are hardly being studied at all.

OK, maybe they simply have a slightly different manifestation of chronic migraine. But what if there are actual biological differences in these patients? That could mean that treatment that work might be quite different for them.

As the researchers write in their abstract:

They may have a longer lasting migraine and different response to treatment. Patients with chronic migraine and daily headache may have complex pathophysiological mechanisms that favor the daily manifestation of migraine
Chronic migraine with daily headache. Literature review

The only bit of treatment wisdom that they pulled out for the abstract was that OnabotulinumtoxinA (Botox) may be useful for these patients. But they admit simply that “management of these patients is a therapeutic challenge”. Indeed!

We need to find a way to better help these patients, and part of that is actually taking the time to study which treatments work best for them, even if they represent a smaller percentage of migraine patients.

Do you suffer from chronic migraine as well as daily headaches? Have you been shut out of a trial or treatment or service because of it? What treatments have you found helpful?

8 June 2020

Should Botox Treatment be more “Standardized”?

James Discoveries & Stats, Medications, Treatments Allergan, Botox for migraine, onabotulinumtoxinA, PREEMPT 0

Botox, generic name onabotulinumtoxinA, has become a common preventative treatment for migraine. But as we have noted before, you may get a different treatment depending on which doctor you go to.

During the last weeks of 2019, an anonymous questionnaire was sent to headache doctors to see just how they were using Botox, and the results might surprise you. But first, a little background.

A protocol has emerged to attempt to standardize Botox treatment, known as the PREEMPT protocol (named after Botox clinical trials). Allergan, the company that makes Botox, promotes this protocol as you can see here:

So there’s no doubt that Allergan wants doctors to use this protocol. But what did the study show?

Units? About 63% didn’t follow the protocol. “Proven sites”? Almost 58% didn’t follow the protocol. And 70% changed the injection sites. In fact, 77.5% of doctors said simply that they did not always follow the PREEMPT Paradigm.

Why not?

Going only by the abstract, the researchers explained: “The main reported reasons for changes in number, dose, and location of injections included adapting to the patients’ pain, anatomy, and preferences.”

That’s not really very specific, but the changes had to do with both doctor’s and patient’s “preferences”.

It should be noted that although some of these doctors were fairly new when it came to this treatment, many were quite experienced. In fact, 71.4% had more than three years’ experience.

The fact of the matter is that onabotulinumtoxinA research is moving on. Not just clinical trials, but also in the experience of the doctors providing the treatment. There is still a lot that we have to learn about Botox treatment – why does it work better for some patients than others? Could it be that PREEMPT is not the ideal for everyone?

Here you might find helpful some of the more recent articles on Botox treatment:

So the “why not” question is very important. If PREEMPT is the best treatment overall for migraine patients, that doesn’t mean that it’s the best for you. However, if it has the best evidence at the moment, it is a good starting place for most people. There’s a reason why Allergan is promoting this protocol.

But we should be careful to rule out the clinical experience of doctors, and the ongoing studies. What you should do is talk to your doctor and understand why she isn’t following PREEMPT in your case. She may have very good reasons. But it’s up to you to ask and get the answers you need before you start treatment.

Is your doctor adapting to “your anatomy”? Is your doctor simply not aware of PREEMPT? Has experience changed the way your doctor uses Botox for migraine? Ask!

The important message here from this study – be aware that Botox treatment is not standardized. Do your research and be aware of what your doctor is offering.

For more on this study:

2 December 2019

Botox vs. CGRP Inhibitors – the fight begins…

James News, Treatments Ajovy, Botox for migraine, fremanezumab, Migraine Trust, NHS, NICE, onabotulinumtoxinA 0

Are the newcomers to migraine treatment really any better than Botox treatment?

That’s one of the key questions being asked now. And it’s an important one, because it’s affecting migraine patients and their insurance coverage.

Patient and doctors — Are important policies being decided “behind your back”?

For example, in England, NICE (National Institute for Health and Care Excellence) recently decided not to recommend Ajovy (fremanezumab) as one of the drugs provided under the NHS (National Health Service). Why? Because current evidence doesn’t show the Ajovy is that much better than Botox (onabotulinumtoxinA) for patients who have tried several treatments already. And if the difference in success is negligible, the difference in cost is not – onabotulinumtoxinA wins easily.

Botox, once the strange newcomer to migraine treatment, is now an old standard. And it may be difficult for policy makers and insurance companies to accept the newcomers, even if they may be better for some patients.

Interestingly enough, its affect on CGRP may be one of the reasons why onabotulinumtoxinA works for migraine patients, which may explain similar results. But we’re still waiting for some good head-to-head studies to really show us which is “better” – “better”, that is, for most patients in general, not necessarily better for you. Welcome to the real world. (Also see Botox and CGRP – and the Future of Migraine Treatment.)

If new studies confirm that Botox performs as well as CGRP inhibitors, of course doctors may want to recommend Botox first, as a less expensive option, to most patients. But Is that a reason to not recommend the CGRP inhibitors at all? Or not to cover it in an insurance policy?

~~Of course, all this has nothing to do with money and politics.~~ Well, ok, maybe it does. Allergan is busy trying to convince investors that Botox for migraine sales continue strong. And there is some evidence that onabotulinumtoxinA and CGRP inhibitors may turn out to be best friends, because the anti-CGRP drugs may help the migraine-fighting effects of Botox last longer (see Concurrent CGRP Inhibitor and OnabotulinumtoxinA Therapy Boosts Relief in Severe Chronic Migraine).

But with the current expense of the new drugs, and a lack of studies to show long term safety, Botox may still have a surprising advantage.

(You can see in detail the reasoning of NICE in their paper here: Fremanezumab for preventing migraine (pdf). Also see Results of The Migraine Trust’s latest patient survey to inform new migraine drug NICE consultation.)