Nina Riggins, MD, PhD: Predicting Outcomes of Botox Treatment in Chronic Migraine


The assistant professor and neurologist at the University of California San Francisco discussed how the presence of cranial autonomic symptoms (CAS) can be a predictor of the effect of Botox on chronic migraine.

“Right now, in our center we administer 2 rounds of Botox and if patients report no significant improvement, in most of the cases 100 hours or more per month, we are moving onto different treatments. This study might be helpful for the people with moderate to severe cranial autonomic symptoms, if they get another ounce of Botox, they might improve too.”

At the 2019 American Academy of Neurology (AAN) Annual Meeting held in Philadelphia, Pennsylvania, Nina Riggins, MD, PhD, assistant professor and neurologist at the University of California San Francisco, and colleagues, presented findings from a chart review and survey of patients to determine whether the presence of cranial autonomic symptoms (CAS) predict headache benefit from Botox in adults with chronic migraine.

Among the 93 patients enrolled in the study, 9 subjects had no CAS at baseline, 34 subjects had mild symptoms at baseline, and 42 had moderate or severe symptoms at baseline. Investigators reported that 85 subjects had at least 2 rounds of Botox.

Of the subjects with mild CAS, 10 had a 50% or more reduction in headache frequency, of the 42 with moderate or severe CAS and 9 had a 50% or more reduction in headache frequency. Investigators reported that 37 of the 85 participants (39.78%) reported improvement in their CAS intensity.

This finding shows that patients without CAS were more likely to improve from treatment of Botox and those with moderate or severe CAS were less likely to respond to treatment. The investigators reported that Botox could improve CAS after multiple rounds, however, additional studies are needed to explore this finding.

To learn more about their findings, NeurologyLive spoke with Riggins in an interview at AAN.


Riggins N, Ehrlich A, Dapkus L, et al. Does the presence of Cranial Autonomic Symptoms in Chronic Migraine Patients Predict Efficacy of Botox Injections? Presented at: American Academy of Neurology 2019, Philadelphia, PA, May 4—10, 2019.

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