Botulinum toxin injection in the management of chronic migraine: the Saudi experience with a proposal for a new protocol
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ORIGINAL ARTICLE
Botulinum toxin injection in the management of chronic migraine: the Saudi experience with a proposal for a new protocol Hussein Algahtani1 · Bader Shirah2 · Ghassan Sukkar1 · Hatim Bukhari3 · Ibraheem Meftah3 · Asim Alhazmi3 · Abid Alshareef3 · Abdulmohsin Algethami3 · Ammar Alshanqiti3 · Mahmoud Andeejani3 Received: 23 August 2020 / Accepted: 5 October 2020 © Belgian Neurological Society 2020
Abstract There are no data from Saudi Arabia about the use of botulinum toxin for migraine prevention. In this article, we aim to study the clinical profile, safety, and response to treatment with botulinum toxin injection for migraine patients. In addition, we aim to share our experience with the use of botulinum toxin modified injection protocol (5/20/100 protocol) in the management of migraine in Saudi patients. A retrospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The protocol for botulinum toxin injection for migraine in our hospital consisted of injecting five muscles with a total of 20 injection sites consuming 100 units of Onabotulinumtoxin A ( BOTOX®, Allergan, Inc., Irvine, CA). A total of 30 patients were included in our study. The mean frequency of migraine days showed a significant reduction from baseline at 15.61 ± 10.92 days per month to 6.14 ± 6.16 days (9.47 days reduction) after botulinum toxin injection (39.3% reduction; paired t test = 5.177; p = 0.0001). The frequency of using abortive medications was reduced in 19 patients (63.3%). Only four patients (13.3%) achieved a headache-free status. Only three patients (10%) had adverse events from botulinum toxin injection. In conclusion, botulinum toxin is an effective, safe, and well-tolerated treatment option for the prevention of chronic migraine. Our protocol (5/20/100 protocol) may improve the safety and cost and reduce the incidence of adverse events. Patients who do not respond to our protocol may switch to the standard protocol after the failure of the first treatment session. Keywords Botulinum toxin · Injection · Migraine · Patients · Saudi Arabia
Introduction Migraine is a common chronic debilitating disorder that affects 15% of adults; more than two-thirds of sufferers are females [1]. Globally, it is ranked as the second most disabling disease amongst all disorders with significant morbidity and impairment of quality of life [2]. It is characterized by recurrent attacks of headache that last for 4–72 h with * Hussein Algahtani [email protected] 1
King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 12723, Jeddah 21483, Saudi Arabia
2
King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
3
King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
pulsating quality, unilateral location, moderate or severe intensity, and aggravation by exercise and routine physical activity. Attacks can be accompanied by phot
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