Pediatric Anxiety and BoNT-A Therapy Responsiveness in Chronic Migraine

Presenting at AHS 2022, researchers determined the effect of generalized anxiety disorder on the responsiveness of BoNT-A treatment from pediatric patients with chronic migraine.

Pediatric patients who score higher on tests for generalized anxiety disorder may not respond as well to botulinum toxin type-A (BoNT-A) treatment for chronic migraine, according to study results presented at the 2022 American Headache Society (AHS) Annual Scientific Meeting, held from June 9-12, in Denver, Colorado, and virtually.

There is a correlation between anxiety and heightened migraine intensity and frequency. In order to improve treatment outcomes and patient quality of life, it’s important to understand how anxiety impacts the efficacy of migraine treatments.

Researchers conducted a retrospective analysis of 34 eligible pediatric patients who underwent BoNT-A treatment for chronic migraine. They studied the efficacy of treatment in reducing migraine frequency and intensity in these patients at 9 months following 3 standard BoNT-A injections.

Based on patient response to treatment, the researchers separated the patients into 2 groups — those who responded to treatment and those who did not. Those who positively responded to BoNT-A treatment demonstrated a 50% or greater reduction in frequency of migraine, while nonresponders did not.

Overall, 25 (73%) of 34 patients responded to BoNT-A treatment. Average migraine frequency decreased to 9.9 headaches in 28 days (P <.001) compared with 18.6 headaches in 28 days at baseline. Average migraine intensity also decreased following BoNT-A treatment from 8.1 out of 10 on the pain scale to 4.3 out of 10.

Next, the researchers calculated each patient’s score on the 7-item Generalized Anxiety Disorder (GAD-7). Patients in the nonresponder group were more likely to have generalized anxiety disorder than patients in the responder group. Out of the 9 nonresponder patients, 6 (67%) had GAD-7 scores greater than 15 compared with only 6 out of 25 (24%) of patients in the responder group (P =.040).

“BoNT-A remains a safe and effective therapy for pediatric patients with chronic migraines at 9 months of follow-up,” the researchers concluded. “Generalized anxiety disorder with GAD-7 scores >15 can be a major predictor of poor response to BoNT-A therapy.”


George M, Yu SG, Goenka A. Pediatric generalized anxiety disorder can predict poor responsiveness to BoNT-A therapy. Presented at: AHS 2022 Annual Scientific Meeting; June 9-12, 2022; Denver, Colorado. Poster 186.

This article originally appeared on Neurology Advisor