Current Neurology and Neuroscience Reports

, Volume 12, Issue 2, pp 114–117 | Cite as

OnabotulinumtoxinA in Pediatric Chronic Daily Headache

  • Marielle KabboucheEmail author
  • Hope O’Brien
  • Andrew D. Hershey
Headache (I Garza, Section Editor)


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.


OnabotulinumtoxinA Pediatric Chronic daily headache Disability Migraine Prophylactic treatment Chronic migraine 



Conflicts of interest: M. Kabbouche: is a consultant for Allergan; H. O’Brien: has received grant support from the American Headache Society; Andrew D. Hershey: has board membership with the American Headache Society (travel to meetings); and has been a consultant for MAP Pharma and Allergan.


Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance

  1. 1.
    Abu-Arefeh I, Russel G. Prevalence of headache and migraine in school children. BMJ (Clinical Research). 1994;309:765–9.CrossRefGoogle Scholar
  2. 2.
    •• Dodick W, Turkel C, DeGryse R, Aurora S, Silberstein S, Lipton R, Diener H. OnabotulinumtoxinA for Treatment of Chronic Migraine: Headache: The Journal of Head and Face Pain Volume 50, Issue 6, pages 921–936, June 2010 This is a review of the PREEMPT studies: double-blind placebo-controlled studies on the efficacy of BoNT-A in adults. The FDA approval for chronic migraine in adults was based on these studies. CrossRefGoogle Scholar
  3. 3.
    Bigal ME, Lipton RB, Tepper SJ, Rapoport AM, Sheftell FD. Primary chronic daily headache and its subtypes in adolescents and adults. Neurology. 2004;63:843–7.PubMedGoogle Scholar
  4. 4.
    Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9–160.Google Scholar
  5. 5.
    •• Ahmed K, Hall Oa K, Mack K, Garza I. Experience with Botulinum Toxin Type A in Medically Intractable Pediatric Chronic Daily Headache. Pediatric Neurology.2010:43 (5), 316-319. This is a rare article describing expert opinion and experience on the use of BoNT-A in the pediatric population; the review is limited to 10 patients and is not a placebo-controlled study but is the only full published manuscript in pediatric use of BoNT-A. All previous submissions have been abstracts to different scientific meetings. PubMedCrossRefGoogle Scholar
  6. 6.
    • Hershey AD, Powers S, Vockell AL, LeCates S, Kabbouche MA, Maynard MK. PedMIDAS: development of a questionnaire to assess disability of migraines in children. Neurology. 2001;57:2034–2039 This article describes the factors behind the disability scoring and assessment and is a major tool that is frequently used in clinical practice as well as in research in the pediatric population. PubMedGoogle Scholar
  7. 7.
    Castillo J, Muñoz P, Guitera V, Pascual J. Epidemiology of chronic daily headache in the general population. Headache. 1999;39:190–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Stang P, Osterhaus J. Impact of migraine in the United States: data from the National Health Interview Survey. Headache. 1993;33:29–35.PubMedCrossRefGoogle Scholar
  9. 9.
    Olesen J, Bousser MG, Diener HC, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006;26:742–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Marielle Kabbouche
    • 1
    • 2
    Email author
  • Hope O’Brien
    • 1
    • 2
  • Andrew D. Hershey
    • 1
    • 2
  1. 1.Division of NeurologyCincinnati Children’s Hospital Medical Center, Headache CenterCincinnatiUSA
  2. 2.College of Medicine Department of PediatricsUniversity of CincinnatiCincinnatiUSA

Personalised recommendations