BOTOX Treatment for Both Migraines and Cancer-related Pain: Effect on Quality of Life; Safety and Efficacy

Abstract

BOTOX Treatment for Migraine in patients with cancer: Effect on Quality of Life; Safety and Efficacy Author Migraines are the second most common cause of neurological disorders, affecting 38 million Americans annually. Among this population, cancer patients may experience increased severity of previous migraine diagnosis due to chemotherapeutic regimens or disease progression that lead to significant morbidity and decreased quality of life. Additionally, up to 30% of all patients after radiotherapy suffer from pain not amenable to standard treatment. OnabotulinumtoxinA, or BOTOX injections, are used for migraine prevention with emerging indications for cancer-related pain. A 69 year old female with a history of malignant ER+ right breast cancer s/p lumpectomy presented with intensifying migraines and status migrainosus. The patient has a >30 year migraine history with throbbing pain, phonophobia, photophobia, and aura. She reports intensifying headaches after participation in XTandi/Alpelisib clinical trials. MRI findings revealed multiple new brain and bone metastases. Migraine treatment with rizatriptan, topiramate, hydrocodone, and naproxen provided no relief. 67 unit BOTOX injections significantly decreased patient daily migraine headaches to 1 day/month. BOTOX intervention provided headache stability and control with reduced duration and severity. BOTOX is a safe and effective treatment, making it an attractive adjuvant to chemotherapy in patients with comorbid migraines. Research shows treatment with BOTOX is well-tolerated in cancer patients and can significantly reduce pain by mitigating migraine morbidity and post-surgical pain. However, literature assessing concomitant reductions in cancer-related pain and migraine morbidity from BOTOX treatment are lacking. BOTOX injections provided headache stability and control with reduced duration and severity for a patient suffering from migraines refractory to other treatment strategies with a concomitant breast cancer diagnosis and associated migraine exacerbation.