Graduation Year


Document Type




Degree Granting Department

Environmental and Occupational Health

Major Professor

Stuart Brooks, M.D.

Committee Member

Thomas Truncale, D.O.

Committee Member

Daisy Chang, Ph.D.


Chronic daily headache, MIDAS questionnaire, productivity, cost, functional capacity


Objective: To assess patient reported efficacy of Botulinum toxin type-A for the prophylaxis of migraine headaches in patients with frequent migraine headaches prior to initiation of treatment with Botulinum toxin type-A compared to post treatment. Questions addressed include is there a difference in frequency of migraine headaches following treatment with Botulinum toxin type-A, is there a difference in cost of conventional treatment versus Botulinum toxin type-A and is there a difference in quality of life.

Research Plan: Questions addressed patient status prior to the initiation of treatment as well as post treatment. Patient quality of life change, duration and frequency headache improvement are the primary focus. Other considerations included the cost difference between the previous use of other treatment and the periodic treatment with Botulinum toxin type-A.

Methodology: A Cross Sectional study utilizing a questionnaire consisting of a modified Migraine Disability Assessment (MIDAS) questionnaire will be given to patients who had received more than one series of injections. Patients who reported chronic migraine headaches and were refractory to previous treatment methods were screened and placed in programs utilizing intramuscular injection of Botulinum toxin type-A at standard points on the face, Temporalis muscle and paracervical muscles. Clinical Relevance: This assessment is relevant to occupational issues due to the increasing number of patients applying for disability due to uncontrolled migraine headaches as well as lost productivity and reduction in functional capacity for activities of daily living.

Impact and Significance: Patients that are debilitated by recurrent chronic migraine headaches suffer loss of productive time at work and home. Treatment with Botulinum toxin type-A may results in significant relief allowing fewer days lost at work and improved quality of life. There may be significant cost saving if treatment results in discontinuation of other medications previously used for treatment of migraine headaches.

Findings: According to the patients' responses to this survey, it appears that there was an overall improvement in the patients' ability to do work, for those who were employed, as well as their ability to do activities of daily living post treatment with Botulinum toxin-A. Though there were occasionally conflicting data seen in individual cases regarding responses to some of the answers, there appeared to be an overall statistically significant reduction in the mean of responses to the questions. The general implication is consistent with studies that indicate Botulinum toxin-A may be a useful adjunct in the prophylactic treatment of refractory migraine headaches.