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.
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 🙁
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!