Papers of the Week

Onabotulinum toxin type A has shown to be a safe and effective treatment for children with chronic migraines. Our study was to assess the efficacy of the Onabotulinum toxin type A at different intervals after initiation of therapy. We conducted a retrospective and prospective analysis of 34 patients at a Children's hospital who received four rounds of the BoNT-A therapy for the treatment of chronic migraine. Amongst the 34 patients, 25 patients (age range 13-21 years), who responded to the BoNT-A therapy were included in the analysis. Patients received standard 31 injection, 155 unit's protocol. Patients were assessed every 3 months after their initial injection. Reasons for discontinuation of therapy were analyzed. After the first two BoNT-A sessions, significant improvement was observed with a decrease in headache frequency and intensity (p < 0.001). There was further reduction in headache frequency and intensity with the 4th round of BoNT-A therapy, with comparative analysis between the 2nd and 4th round showing a p value of <0.001. In terms of reduction of emergency room visits and hospitalization, a significant improvement was seen after the 3rd round of BoNT-A therapy (p < 0.01). A significant decrease in the number of abortive and preventive medications was seen after the 2nd round of BoNT-A therapy (p <0.001). The efficacy of BONTA treatment in decreasing headache frequency, intensity, and the number of abortive and preventive medications can be assessed effectively after two treatment sessions. This trend continued to be observed with an additional third and fourth session.