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Date of Award
Spring 2020
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Elizabeth Masten, MSPAS, PA-C
Second Advisor
ToriAnne Yetter, MSPAS, PA-C
Abstract
Introduction: Migraine is a severe form of headache characterized by unilateral, pulsating pain in one particular area with varying intensity. They are often accompanied by other symptoms such as nausea, vomiting and sensitivity to sound or light. Migraine is classified as episodic (< 15 days per month) or chronic (> 15 days a month). This paper addresses patients 18 and above that suffer with chronic migraine. The mainstay of treatment for migraine is primarily symptomatic with medications such as NSAIDS, Ergot alkaloids or triptans. Research for treatment of chronic migraine has most recently taken a prophylactic approach. A commonly used medication used for prevention of chronic migraine is the anti-convulsant Topamax (Topiramate). More recently, in hopes to find a treatment with less systemic side effects, research has shown effectiveness of Botox (OnabotulinumtoxinA) injections for prophylaxis of chronic migraine. This paper will address the efficacy and side effect profile of Topamax compared to Botox injections for the management of chronic migraine in adults.
Methods: A literature search was conducted through PubMed and Google Scholar in November 2018. A total of seven articles were selected based on relevance, study design and result yield. The articles study design and results were analyzed and compared to one another.
Results: The evidence collected by each of the studies demonstrated statistically significant improvement in chronic migraine patients treated with Botox injections and Topamax. Three of the studies comparing Botox and Topamax showed a 50% decrease in the amount of headache days per month and a decrease in severity of headache days. However, the evidence collected was not strong enough to confirm the replacement of Topamax with Botox as a first line treatment. The other three studies demonstrated a statistically significant improvement in symptoms in patients treated with Botox compared to placebo.
Discussion: All of the articles demonstrated positive results for the efficacy of Botox as a preventative treatment for chronic migraine. The articles that compared Botox and Topamax also showed positive results and a similar efficacy with no statistically significant difference. The articles had different study designs, study lengths and treatment regimens which made it difficult to compare them to one another. Overall, the research gathered suggests that Botox is a viable treatment option for the prevention of chronic migraine but there is not enough evidence to say that it is more effective than treatment with Topamax.
Conclusion: Chronic migraine is a debilitating condition that is underdiagnosed and undertreated. The six studies selected for review found significant improvement in chronic migraine symptoms with the use of Botox. Three of those studies also found that Botox and Topamax provide a similar efficacy in treatment of chronic migraine. The side effect profile for Botox and Topamax were differing but showed that patients were more likely to cope with the side effects of Botox compared to Topamax. Future research is warranted in order to determine the long-term effects of Botox and larger sample sizes are necessary to address the deficiencies of the research on this topic.
Recommended Citation
Haines, Nicole, "Efficacy of Botox Injection Compared to Topamax for Prophylactic Treatment of Chronic Migraine in Patients Ages 18 and Above" (2020). Capstone Showcase. 78.
https://scholarworks.arcadia.edu/showcase/2020/pa/78
Efficacy of Botox Injection Compared to Topamax for Prophylactic Treatment of Chronic Migraine in Patients Ages 18 and Above
Introduction: Migraine is a severe form of headache characterized by unilateral, pulsating pain in one particular area with varying intensity. They are often accompanied by other symptoms such as nausea, vomiting and sensitivity to sound or light. Migraine is classified as episodic (< 15 days per month) or chronic (> 15 days a month). This paper addresses patients 18 and above that suffer with chronic migraine. The mainstay of treatment for migraine is primarily symptomatic with medications such as NSAIDS, Ergot alkaloids or triptans. Research for treatment of chronic migraine has most recently taken a prophylactic approach. A commonly used medication used for prevention of chronic migraine is the anti-convulsant Topamax (Topiramate). More recently, in hopes to find a treatment with less systemic side effects, research has shown effectiveness of Botox (OnabotulinumtoxinA) injections for prophylaxis of chronic migraine. This paper will address the efficacy and side effect profile of Topamax compared to Botox injections for the management of chronic migraine in adults.
Methods: A literature search was conducted through PubMed and Google Scholar in November 2018. A total of seven articles were selected based on relevance, study design and result yield. The articles study design and results were analyzed and compared to one another.
Results: The evidence collected by each of the studies demonstrated statistically significant improvement in chronic migraine patients treated with Botox injections and Topamax. Three of the studies comparing Botox and Topamax showed a 50% decrease in the amount of headache days per month and a decrease in severity of headache days. However, the evidence collected was not strong enough to confirm the replacement of Topamax with Botox as a first line treatment. The other three studies demonstrated a statistically significant improvement in symptoms in patients treated with Botox compared to placebo.
Discussion: All of the articles demonstrated positive results for the efficacy of Botox as a preventative treatment for chronic migraine. The articles that compared Botox and Topamax also showed positive results and a similar efficacy with no statistically significant difference. The articles had different study designs, study lengths and treatment regimens which made it difficult to compare them to one another. Overall, the research gathered suggests that Botox is a viable treatment option for the prevention of chronic migraine but there is not enough evidence to say that it is more effective than treatment with Topamax.
Conclusion: Chronic migraine is a debilitating condition that is underdiagnosed and undertreated. The six studies selected for review found significant improvement in chronic migraine symptoms with the use of Botox. Three of those studies also found that Botox and Topamax provide a similar efficacy in treatment of chronic migraine. The side effect profile for Botox and Topamax were differing but showed that patients were more likely to cope with the side effects of Botox compared to Topamax. Future research is warranted in order to determine the long-term effects of Botox and larger sample sizes are necessary to address the deficiencies of the research on this topic.