Article Text

other Versions

Download PDFPDF
Effectiveness of onabotulinumtoxinA (BOTOX) in pediatric patients experiencing migraines: a randomized, double-blinded, placebo-controlled crossover study in the pediatric pain population
  1. Shalini Shah,
  2. Michael-David Calderon,
  3. Nikhil Crain,
  4. Jason Pham and
  5. Joseph Rinehart
  1. Department of Anesthesiology & Perioperative Care, University of California Irvine Health, Orange, CA, 92868
  1. Correspondence to Dr Shalini Shah, Department of Anesthesiology & Perioperative Care, University of California Irvine Health, Orange, California, USA; ssshah1{at}


Introduction OnabotulinumtoxinA (OBTA) is approved for treating chronic headaches and migraines in adults, but there is limited scientific literature on the outcomes in pediatric patients. The aim of this study was to determine if subjects treated with OBTA reported a statistically significant improvement in the primary features (frequency, intensity, duration and disability scoring) associated with migraines compared with placebo at follow-up visits.

Methods After obtaining approval by the appropriate local (HS# 2016–3108) and federal institutions, the principal investigator enrolled candidates aged 8 to 17 years old diagnosed with chronic migraines (at least 6 months), and 15 or more headache days in a 4-week baseline period. This randomized control trial consisted of two phases: double-blind and open-label for the first two and last two sets of treatments, respectively. Subjects were randomly assigned to receive a treatment protocol—155 units at 31 injection sites—in 3-month intervals and follow-up visits every 6 weeks. Non-parametric testing (Wilcoxon signed-rank test) was performed using widely available open-source statistical software (‘R’).

Results From February 2017 to November 2018, 17 subjects presented for a screening visit; 15 met eligibility criteria. Subjects that received OBTA reported a statistically significant decrease from the following baseline values compared with placebo 6-week post-treatment compared with placebo: frequency (20 (7 to 17) vs 28 (23 to 28); p=0.038), intensity (5 (3 to 7) vs 7 (5 to 9); p=0.047), and PedMIDAS (Pediatric Migraine Disability Score) (3 (2 to 4) vs 4 (4 to 4); p=0.047). There was no statistically significant difference in the duration (10 (2 to 24) vs 24 (4 to 24); p=0.148) of migraines between the two groups.

Discussion OnabotulinumtoxinA showed a statistically significant decrease in frequency and intensity of migraines compared with placebo. No adverse effects or serious adverse events related to the use of OBTA were reported. In the future, we aim to evaluate the specific nature of migraines, for example, quality/location of pain presented during an initial consult to predict the likelihood of OBTA being a truly effective modality of pain management for pediatric migraineurs.

Trial registration number NCT03055767.

  • pediatrics
  • chronic pain
  • pain management

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @ShaliniShahMD

  • Contributors All listed authors have made substantial contributions to the study and submitted manuscript.

  • Funding American Society of Regional Anesthesia and Pain Medicine (ASRA).

  • Competing interests SS is a consultant for Allergan, Inc, however not during the period of this study.

  • Patient consent for publication Not required.

  • Ethics approval Institutional Board approval was obtained at the University of California, Irvine HS# 2016-3108.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data supporting the findings of this study are available from the corresponding author upon reasonable request.