Background: In the past decade, botulinum toxin type-A (BTX-A) has been used to treat a wide range of disorders characterized by undesirable muscle hyperactivity and is widely considered to be the treatment of choice for most kinds of focal dystonia. Recently, several reports suggest that BTX-A may also be a useful therapy for chronic headaches, including migraine. Patient selection criteria, best treatment paradigms, and most useful outcome measures are, however, still being defined.
Objective: To assess the benefits of BTX-A in the treatment of difficult-to-treat chronic headache by evaluating its impact on acute medication usage.
Subjects and Methods: Five migraine patients with unsatisfactory responses to conventional therapy received injections of BTX-A (40 to 100 unites total) into regions of greatest discomfort, including frontalis, temporalis, cervical paraspinals, and trapezius. Reinjection occurred at 3-month intervals for 1 year. Medication usage before and during BTX-A treatment was determined using the annualized cost of all headache-related prescriptions. Other medical costs (physician/Emergency Dept. visits) were excluded. The net change in medication costs was calculated for each patient (including the cost of BTX-A treatment of $370 per 100 units).
Results: Annualized costs for non-BTX-A medications ranged from $1002 to $3524 per year pretreatment, compared with $0 to $1285 per year after BTX-A treatment. Factoring in the cost of BTX-A treatment, the net medication cost decreased in 3 of the 5 patients (cost range: an increase of $648 per year to a decrease of $2717 per year). All patients were "much improved" or "doing well" with BTX-A treatment. Symptoms typically improved 3 to 4 days after BTX-A injection, and were maximally reduced over the 2 months following treatment. No adverse events were reported.
Conclusion: BTX-A induced decreases in the frequency and/or severity of chronic headaches led to decreased headache medication costs. A reduction in ED and office visits may provide further savings.