INJECTABLE BOTULINUM TOXIN METHODS FOR TREATING HEADACHES
Provided is an invention based on methods to treat or prevent headaches with injectable compositions comprising botulinum toxin that may be administered using an injection paradigm that provides botulinum toxin at one or more locations of neuronal activity associated with EEG detectable brain cortical electrical activity to a subject suffering from such malady. Co-therapeutics therewith are also disclosed.
1 . A method of treating or reducing frequency of headaches in an individual in need of treatment, the method comprising:
administering by injection an injectable botulinum toxin composition to a plurality of injection sites, each of the plurality of injection sites selected from electrode placement sites for detecting neuronal activity with EEG to achieve the therapeutic effect following treatment with the botulinum toxin composition;
wherein the botulinum toxin composition comprises a botulinum toxin and pharmaceutically acceptable diluent suitable for injection.
2 . The method according to claim 1 , wherein the headache is selected from migraine headache, a post-traumatic headache, a post-craniotomy headache, tension-type headache, cluster headache, and medication-overuse headache.
3 . The method according to claim 1 , wherein the headache is a migraine headache and is an episodic migraine headache.
4 . The method according to claim 1 , wherein the headache is a migraine headache and is a chronic migraine headache.
5 . The method according to claim 4 , wherein the episodic migraine headache is a high-frequency episodic migraine.
6 . The method according to claim 1 , wherein the botulinum toxin is of serotype A.
7 . The method according to claim 6 , wherein the botulinum toxin has a molecular weight of 150 kDa.
8 . The method according to claim 1 , wherein the composition further comprises a positively charged carrier comprising a positively charged backbone and at least one efficiency group, wherein the positively charged efficiency groups are selected from an amino acid sequence selected from the group consisting of (gly)p-RGRDDRRQRRR-(gly)q (SEQ ID NO: 2), (gly)p-YGRKKRRQRRR-(gly)q (SEQ ID NO: 3), and (gly)p-RKKRRQRRR-(gly)q (SEQ ID NO: 4), wherein the subscripts p and q are each independently an integer of from 0 to 20 and mixtures thereof
9 . The method according to claim 8 , wherein the positively charged efficiency groups include the amino acid sequence RKKRRQRRR-(gly) q -(K)x-(gly) p -RKKRRQRRR, wherein the subscript x is an integer from 5 to 50 or 10-30 or 10 to 20, wherein p and q are each an integer from 0 to 8.
10 . The method according to claim 9 , wherein the positively charged efficiency groups has the amino acid sequence RKKRRQRRRG-(K)15-GRKKRRQRRR.
11 . The method according to claim 1 , wherein the injection sites correspond to electrode placement sites Fpz, Fp1, Fp2, F3, F4, F7, F8, T3, T4, C3, C4, A1, A2, P3, P4, T5, T6, 01, 02, GND1, GND2, or any combination thereof.
12 . The method according to claim 11 , wherein the injection sites further include a trapezius muscle or a masseter muscle or both.
13 . The method according to claim 12 , wherein the injection sites further correspond to electrode placement sites Cz, Oz, Fz, or any combination thereof.
14 . The method according to claim 13 , wherein the composition is administered at 10 to 25 injection sites.
15 . The method according to claim 1 , wherein the composition is administered to the injection sites consisting of electrode placement sites Fp1, Fp2, T3, T4, T5, T6, 01, 02, F3, F4, P3, P4, F7, F8, GND1, GND2, and Fpz.
16 . The method according to claim 1 , wherein the composition is administered to the injection sites consisting of electrode placement sites Fp1, Fp2, T3, T4, T5, T6, 01, 02, F3, F4, P3, P4, F7, F8, GND1, GND2, and Fpz, and right and left trapezius muscle.
17 . The method according to claim 1 , wherein the composition is administered to the injection sites consisting of electrode placement sites Fp1, Fp2, T3, T4, T5, T6, 01, 02, F3, F4, P3, P4, F7, F8, GND1, GND2, and Fpz, and right and left trapezius muscles and a masseter muscle or both right and left masseter muscles.
18 . The method according to claim 1 , wherein the total treatment dose of botulinum toxin component administered to the individual is 100 U to 450 U.
19 . The method for use according to claim 1 , wherein the injection volume for one injection site is from 100 to 400 μL.
20 . The method according to claim 1 , further comprising administering to the individual one or more co-therapeutics selected from an antagonist of calcitonin gene-related peptide (CGRP-antagonist), 5-HT-1F receptor agonist and ergot compounds.
21 . The method according to claim 20 , wherein the co-therapeutic is a CGRP antagonist and the CGRP-antagonist is an anti-calcitonin gene-related peptide receptor antibody (anti-CGRP antibody) or an antigen-binding fragment thereof
22 . The method according to claim 21 , wherein the anti-CGRP receptor antibody is selected from galcanezumab, fremanezumab, eptinezumab, erenumab, and combinations thereof
23 . The method according to claim 21 , wherein the CGRP-antagonist is a gepant.
24 . The method according to claim 21 , wherein the CGRP-antagonist is administered separately, sequentially, or simultaneously with the injectable botulinum toxin composition.
25 . The method according to claim 20 , wherein the individual is a non-responder or insufficient responder to one or more triptan drugs.
26 . The method according to claim 20 , further comprising administering to the individual a 5-HT-1F receptor agonist.
27 . The method according to claim 26 , wherein the injectable botulinum toxin composition, the CGRP-antagonist, and the 5-HT-1F receptor agonist are administered separately, sequentially, or simultaneously.
28 . The method according to claim 20 , further comprising administering to the individual an ergot compound.
29 . The method according to claim 28 , wherein the ergot compound is selected from ergotamine tartrate, ergonovine maleate, and ergoloid mesylates.