HQ Team
May 10, 2024: Botox has been traditionally used to treat migraine, but there is not enough data available to prove its efficacy. A new study assessing the diagnostic capacity of Botox in identifying migraine trigger sites came up with positive results.
Hassan ElHawary, M.D., from the McGill University Health Centre in Montreal, and colleagues examined the diagnostic capacity of Botox in a sensitivity analysis performed on 40 patients receiving Botox for migraine trigger site localization followed by a surgical decompression of affected peripheral nerves. The patients were followed up for 3 months and a year.
Botox positivity for migraines
The researchers found that the diagnostic targeted Botox injections had a very high positive predictive value and could be useful in diagnostic modality to identify migraine trigger sites and improve preoperative patient selection.
The study found that patients with successful Botox injections (defined as at least 50% improvement in Migraine Headache Index scores after injection) had significantly higher average reduction in migraine intensity (56.7% ) and frequency (78.1%. Sensitivity analysis showed that the use of Botox injection as a diagnostic modality for migraine headaches has a sensitivity of 56.7% and a specificity of 80.0%.
“Our study supports the value of preoperative Botox injections as a reliable diagnostic tool for identifying patients who will respond to migraine surgery, with a positive predictive value of nearly 90 percent,” coauthor Jeffrey E. Janis, M.D., of The Ohio State University Wexner Medical Center in Columbus, said in a statement. “We recommend the routine use of diagnostic Botox injections as well as nerve blocks with the goal of confirming trigger sites and identifying patients who are more likely to benefit from migraine surgery.”
Migraines
Migraines affect over 1 billion people worldwide. It is associated with intense debilitating pain, with estimates reaching as high as 45 million years lived with disability because of migraines globally.
Migraines were perceived as a central neurovascular disease. However, several key studies have shown that specific peripheral nerve trigger sites can play a major role in the development of migraine headaches. Hence, peripheral nerve deactivation surgery has evolved as a possible solution and treatment modality in the last two decades. However, a recent study has demonstrated that the outcomes could be significantly successful in some or not at all in others.
Migraine triggers currently are identified by muscle probe and physical examination, doppler test, and an anesthetic in an active headache case to identify the vascular trigger. Botox can also be used and a positive response confirms the presence of a trigger site. Researchers say that only muscular compression alone cannot be attributed for the migraine. Neurotransmitter release, inhibition of peripheral fibre sensitisation, and neurogenic inflammations can also contribute.
The US Food and Drug Administration approved Botox injections as a treatment modality for migraine headaches in 2010.
The study was published in the Plastic and Reconstructive Journal.
