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The FDA has approved injection of onabotulinumtoxinA (Botox – Allergan) for prevention of headaches in adult patients with chronic migraine (≥15 headache days/month for ≥3 months). It is the first drug approved for treatment of this indication. Botox is also FDA-approved for treatment of upper limb spasticity, axillary hyperhidrosis, cervical dystonia, blepharospasm and strabismus, and for cosmetic reduction of wrinkles.
MIGRAINE PROPHYLAXIS — Beta-blockers and tricyclic antidepressants are commonly prescribed for prevention of episodic or chronic migraine. In randomized controlled trials, the efficacy of the antiepileptic drugs valproate (Depakote, and others) and topiramate (Topamax, and others) in preventing episodic migraine was similar to that of propranolol. Topiramate has also reduced the number of migraine headaches per month in patients with chronic migraine.
4. NT Mathew and SFA Jaffri. A double-blind comparision of onabotulinumtoxinA (Botox) and topiramate (Topamax) for the prophylactic treatment of chronic migraine: a pilot study. Headache 2009; 49:1466.
6. AWP cost according to Red Book 2010.