A case demonstrating how a combination of Botox and erenumab can improve person’s quality of life: research from a Quebec team
Both Botox and CGRP antibodies can be effective for Chronic Migraine. Still, 50 to 50% of patients do not get this response for Botox or CGRP antibodies. What if a combination was used?
A team from Quebec City reports on a 52 years-old woman suffering from chronic migraine. This woman had tried other preventives (amitriptyline, propranolol, duloxetine, candesartan, verapamil) and she was using a lot of acute meds (rizatriptan, fiorinal ¼, Gravol, Demerol, Tylenol and medical cannabis).
Over a year and a half, she was treated with either Botox alone, Aimovig alone or a combination, with four phases. In the end, the conclusion was that the combination was required for her to be optimally controlled.
| Before treatment | Botox phase Nov 2017 | Botox + Aimovig Dec 2018- Feb 2019 | Aimovig only March-May 2019 | Botox + Aimovig July-Sept 2019 | |
| Number per month on a mean over the observation period Similar improvements were seen for Gravol, Fiorinal and cannabinoid use | |||||
| Migraine Days | 27 | 18 | 10 | 15 | 1 |
| ER visits | 3-4 | 1 | 0 | 2 | 0 |
| Triptan dose | 9,8 | 6,3 | 4,7 | 9 | 1,5 |
| Tylenol dose | 67 | 42 | 33 | 110 | 30 |
| Demerol dose | 10 | 7,5 | 5,8 | 14 | 3,6 |
The authors detail many arguments to support the combination of Botox and a monoclonal antibody. A post from Migraine Canada can be found here.
This case is only one case.
It is not a research on hundreds of people with elaborate statistics. It is not an ultimate proof. But this person’s story illustrates a few important things about people with chronic migraine:
- They do not always improve with oral preventives
- They sometimes need to go to the emergency department
- They may have to use opioids and cannabinoids, even if these are not ideal options
- They can get better even after years of suffering
- The optimal goal should be the lower attack frequency as possible, with 4-6/month being a target for Chronic Migraine starting at 15 or more.
Research makes a difference. We need more research on migraine and headaches in Canada!
Stay tuned, as Migraine Canada may post calls for testimonials and stories about migraine treatments.
11 Comments
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This is great but let’s figure out how to get migraine sufferers in Canada coverage.
YES!!!! I have been getting Aimovig for the past 6 months as kind of a trial but now not sure whats going on, I don’t have insurance besides RAMQ and not sure if I can continue, imagine adding Botox to that 🙁
I have been taking aimovig for the last 5 months with the magic trial and it has worked wonders!! One on the only medications that has actually helped I wish there was more coverage as well!!
As a person who lives with Migraines ( 6years of 7- 17days per month With DAILY headaches) I currently use Aimovig and have found it has lowered the frequency and intensity of my migraines. As well as my migraines last only a day or two instead of 3-5 as previously.
I had used Botox and Aimovig for the 1st 3 months Of my Aimovig treatments and found it much more effective, but my insurance would not cover it and Aimovig’s Bioscript plan would not continue coverage if I continued using Botox as well!
I have been to every type of specialist my city has to offer ,3 Neurologist’s , 4 pain specialists, 4 physicians and not one has ever suggested a migraine/headache testing, trials,.
I have to research and request any blood tests, possible solutions…..I might as well have a medical license at this point!
The quality of life for chronic migraine sufferers is challenging to say the least, so it would be nice to have some doctors as advocates who do more testing, and have better pain relief!
I total agree with you! It feels great to find someone who feels the same way, I’m not crazy!
As a person with headaches 365 days out of 365 days in a year and a dozen migraines a month, I am on 250units of botox, tried and stopped Aimovig and now am on Emgality. No results with aimovig, emgality has reduced severity and frequency a bit so far. I also do physio and chiro 3 times a week. I now take Tramacet multiple times daily to help mitigate. Wish there was an easy answer.
I’ve been using Aimovig since last year, it was amazing my migrains had gone from 5 per week to 3 per month. But now since June I am back to 5 per week… Need to go see my Neurologist again, maybe combining with Botox could be a solution.
Moi la combinaison est parfaite mais les assurances ne sont pas ouverte a l’idée
Je suis de celle qui a une reaction EXTRAORDINAIRE avec les 2 traitements, malheureusement, jai du faire le choix. Et il m’est impossible de me payer le botox. J’avais de la migraine TOUS LES JOURS avec le botox on a diminué de 30% et avec Aimovig de 50% donc avec les 2 on avait meme plus que 80% des migraines réduite, disparue et même les crises VRAIMENT plus facile à traiter. Donc je revois une parcelle de ma vie retomber dans les entrailles des obligations de la noirceur tel une vie de vampire! Je deteste ne pas être comme les autres, voir si j’ai choisi ma condition! 🥺
I had 30 days migran per month. Tried botox and at 350 units my migran was down to 15 days per month.
So, stoped botox and tried aimovig 70 but nothing happens, tried aimovig 140 and yes!, my mirgran is down to 8 days per month. And not so heavy and can be helped with sumatriptan 100 mg+ ipensa 400 mg.
But now i get 200 units botox every 12 week and aimovig 140 every 4 week.
Hopefully this combo gets these 2 days per week and i gets free from migrane 👏
So dont give up, dont stop trying ❤️
I would like to take part in a case like this. I have MBA and have had to leave my job, no longer drive, and can’t care for my grandchildren any longer. It is a real struggle to have such life changes that are happening to me. I am on Aimovig right now. My dr would like me to have botox but my insurance company will not approve both and I can’t afford to pay myself.