Will Botox Work for You? A New Clue in Your Blood…

Botox injections sometimes help some migraine patients.  But with so many other treatments to try, and with the expense of Botox treatments, many patients aren’t willing to risk it with that “sometimes … some” disclaimer.

Of course, this is an issue with ever migraine treatment out there.  And so researchers are pushing to find out why – why does [this treatment] work for Jessica, but not for Emily?

Using Botox (onabotulinumtoxin type A), researchers in Spain wanted to know if a blood test could predict how well Botox treatments would work.  They chose two indicators – two peptides that can be measured in the blood – calcitonin gene-related peptide (CGRP) and vasoactive intestinal peptide (VIP).

Both of these peptides are well known in migraine research.  CGRP is a particular hot spot in migraine research today – you can read about it in The Secret of CGRP, and learn about the race to approve a CGRP-related migraine drug in New Migraine Drugs: What About CGRP?

It has been theorized that onabotulinumtoxin type A works because of the way it blocks the release of CGRP.

The most striking results came from testing levels of CGRP.  The chart below shows how likely the patient is to respond well to Botox treatment:

If the level of CGRP in a patient was above 72 pg/ml, they were 28 times more likely to respond well to onabotulinumtoxin type A treatment.

Results with VIP were less obvious, but even then patients with low CGRP were more likely to respond if VIP levels were high.

Knowing how well Botox treatment will work is notoriously tricky, because not only do you have different patients, you also have different doses, injection sites, and intervals of treatment.  But it would be a significant help if, with a blood test, we could know that Jessica is a good candidate for Botox while Emily is not.

This research tells us something else – it’s another clue that we may be on the right track when it comes to CGRP.  The many CGRP medications currently in clinical trial may help many migraine patients that have not been helped before.

Study abstract:  CGRP and VIP levels as predictors of efficacy of onabotulinumtoxin type A in chronic migraine.

See also Predicting response to Botox injections and Botox Treatment For Migraines.