Both Botox and CGRP antibodies can be effective for Chronic Migraine [1]. 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 [2]. This woman had tried other preventives (amitriptyline [3], 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 [4].
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 [5]
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.