People living with chronic migraine often reach a point where headaches begin to occur on most days of the month. When this happens, migraines can start to interfere with work, sleep and everyday life.
At this stage, standard migraine medications may no longer provide enough relief, and many patients begin looking for other options that could help reduce the frequency of their attacks.
One treatment that may be recommended in these situations is Botox injections.
Although Botox is widely known as a cosmetic treatment used to smooth wrinkles, it has also been shown to help some people living with chronic migraine. It has been licensed for this use since 2010 and can significantly reduce the number of headache days in suitable patients.
Botox is not a cure for migraine, but for some individuals it can significantly reduce how often attacks occur and improve daily life.
What type of migraine does Botox work for?
Botox only works for chronic migraine.
This refers to people having 15 or more headache days a month, of which at least half are migraines.
It does not work for other types of headache.
Botox is not effective for:
- Occasional migraine
- Tension-type headaches
- Cluster headaches
Botox has been approved for the treatment of chronic migraine by the National Institute for Health and Care Excellence (NICE) and by the FDA.
Because several headache disorders can cause similar symptoms, a careful diagnosis is important before this treatment is considered.
How does Botox help migraine?
No one really knows for sure exactly how Botox helps migraine.
It is thought that Botox blocks pain signals in key nerve pathways involved in migraine. The effect it has on the muscles is thought to be irrelevant for headaches.
If successful, Botox can cut the number of headache days in half.
Research suggests Botox may work by reducing the release of certain chemicals involved in pain signalling and by decreasing the sensitivity of nerves involved in migraine pathways.
Clinical studies have shown that many patients experience around a 50% reduction in monthly headache days after treatment.
How is Botox given for migraine?
Botox is injected around the head and neck using a tiny needle that feels like a pin prick and takes about 15 minutes to do.
The treatment is repeated every 12 weeks if successful. The response from the treatment can take a few weeks to become noticeable.
Treatment usually involves multiple small injections placed in specific areas around the head and neck.
Doctors often assess the benefit after two treatment cycles before deciding whether the treatment should continue.
What are the side effects?
The most common side effect is neck pain, which occurs in around 1 in 10 patients.
More uncommon side effects include muscle stiffness, weakness and spasm and a few patients develop eyelid drooping.
Most side effects are mild and temporary.
No serious irreversible side effects have been reported in trials of Botox thus far.
Is Botox approved for migraine?
Yes.
Botox is:
- Approved by NICE in the UK for chronic migraine
- Approved by the FDA in the United States
In clinical practice, Botox is usually considered when other preventive migraine treatments have not provided enough benefit.
FAQs
How many injections are needed for migraine treatment?
Botox treatment for chronic migraine usually involves multiple small injections across several areas of the head and neck. These injections target muscles and nerves involved in migraine pathways.
The exact number of injections may vary slightly depending on the treatment plan.
How long does Botox for migraine last?
The effects of Botox usually last around 12 weeks.
If the treatment is effective, injections are typically repeated every three months to maintain the benefit.
Can Botox stop migraines completely?
Botox does not cure migraine.
However, for people with chronic migraine it can significantly reduce the number of headache days and improve quality of life.
About the author
Dr Mohjir Baloch is a Consultant in Pain Management with nearly 20 years of experience treating acute and chronic pain conditions. He works across several hospitals in the UK, including Guildford, Windsor and Farnham, and is Lead Clinician at Frimley Park Hospital. Trained in Anaesthetics and Pain Medicine at Guy’s and St Thomas’s Medical School and St Bartholomew’s Hospital, he specialises in interventional pain treatments for conditions such as spinal disorders, osteoarthritis and neuropathic pain, and is actively involved in training doctors in Pain Medicine.
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