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Can Botox Reduce Self-Injurious Behavior in Young Patients with Chronic Head Pain and Autism/Developmental Delay?

Victoria Karian, Cindy Yu-Hsing Chang, Zoe J. Schefter, Alyssa Lebel

Autism Spectrum Disorder (ASD) is characterized by neurological, psychiatric and medical comorbidities, revealed in childhood, often including intellectual disability. Migraine is a very common neurological disorder, characterized by moderate to severe head pain. It is likely that experiencing severe migraine head pain might lead a young person with ASD to self-injurious behavior, such as striking or banging their heads. Botox for chronic migraine protocol is used to treat patients with frequent migraine episodes. While this protocol is off-label for persons under 18 years, it has been used with good efficacy to treat teenagers with chronic migraine and head pain. Two patients in our headache clinic population were identified as having ASD/intellectual disability, chronic migraine pain and self-injurious behavior. These patients underwent the Botox for chronic migraine protocol every 12 weeks, had significantly decreased migraine and head pain frequency, and subsequent reduction in self-injurious behavior.