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|
|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|
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.