Could Botox help ease chronic pain in children?
While the drug, which is actually a mild toxin that paralyzes muscles, is better known for its cosmetic benefits as a wrinkle remover, it has been very effective as a preventive treatment for adults with chronic migraines since the FDA approved its use in 2010.
However, there’s no equivalent treatment approved for children, says Dr. Shalini Shah, director of the UC Irvine Health Center for Pain and Wellness and an assistant professor in the UC Irvine School of Medicine Department of Anesthesiology and Perioperative Care.
She treats dozens of children every year with severe chronic migraines at the Gottschalk Medical Plaza in Irvine.
“Over the last five years, I’ve selectively used onabotulinumtoxin A ‘off label’ for pediatric patients whose migraines don’t respond to other treatments,” Shah says.
One of those patients is 9-year-old Manu Teave. The third grader from Westminster had been suffering from debilitating migraines since he was age 5 due to a rare brain condition known as Arnold-Chiari malformation.
“He was having severe headaches and frequent nausea, and he just he felt out of it,” notes his mother, Jacqueline Teave. “He stopped going to school and doing activities, even playing with his brother. We pretty much lived in the hospital.”
Working with Shah, Manu began receiving Botox injections in his forehead, temples, above his ears and in the back of his head every three months. This, combined with ganglion block therapy and other medications when the Botox starts wearing off, has resulted in a dramatic decrease in his pain.
“Anecdotally, the results are so impressive and have such a positive impact in these patients’ lives, that this therapy option ought to be studied in a controlled setting to demonstrate whether it has a clinical value and to validate existing treatment strategies,” Shah said.
The medical literature estimates that one in three children will experience chronic headaches in their lifetime, which increase as they reach adolescence. Shah says migraines make up nearly 60 percent of all visits to a pediatric headache specialist.
No clinical trials — yet
No trials currently exist in literature studying onabotulinumtoxin A for efficacy or safety for treatment of pediatric migraines. A clinical trial is now recruiting patients for this experimental treatment. Read more about the trial ›
Scientists have demonstrated the negative impact of having childhood migraine on overall quality of life is similar to pediatric cancer, heart disease and rheumatic disease. As the frequency of migraine attacks increase, so does proportionally the child’s disability in lost school time and family and social interactions.
Among adults, it’s estimated that healthcare costs are 70 percent higher for a family with a migraine sufferer than without, and direct medical costs for children with migraine are reported to be similar to those for adults.
A 'happy kid' again
As for Manu, his mom reports: “He’s doing phenomenally. He’s back to normal, back in school and doing sports and activities. Best of all, he’s a happy kid again. The pain used to make him so mean, miserable and angry, but now he has a huge improvement in behavior and attitude.
“All my thanks go to Dr. Shah,” she said. “She’s constantly willing to work with him and explain things. She took on a very complicated case.”