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 treatmentBotox phase
Nov 2017
Botox + Aimovig Dec 2018- Feb 2019Aimovig only March-May 2019Botox + 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 Days271810151
ER visits3-41020
Triptan dose9,86,34,791,5
Tylenol dose67423311030
Demerol dose107,55,8143,6

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. 

Read the full article here

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. 

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