Botox for Chronic Migraine

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Botox received FDA approval for the treatment of chronic migraine in October 2010. It is an injectable form of botulinum toxin used for preventing migraines in adults with chronic migraine (migraines that occur on 15 or more days per month for more than 3 months, which has the features of migraine headache on at least 8 days per month).

How Botox for migraine works

Botox works by blocking the release of certain brain chemicals including acetylcholine and by blocking the movement of certain nerves and muscles. It is not completely known how Botox reduces headache pain and stiffness. A potential reason might be that Botox blocks nerves that send pain messages to the brain and relaxes muscles so they are less sensitive to pain.

Botox’s effectiveness

Patients have differing levels of success with each type of treatment. Some feel reasonably better quickly, while others find their migraine symptoms completely go way. Botox was evaluated in 2 well designed studies that included people who were not using migraine prevention medicines but who were experiencing more than 15 days of probable migraine headache per month lasting at least 4 hours per day. Results included measurable and meaningful differences after 24 weeks as compared to people who received sugar injections including:

  • Number of headache days per 28 days: patients receiving Botox had approximately 2.3 fewer headache days compared to the placebo group (7.8 to 9.2 fewer days for the Botox group, versus 6.4 to 6.9 days for the placebo group, respectively)
  • Patients receiving Botox also experienced a reduction in total headache hours compared to the placebo group.

Forms of Botox available to treat migraines

Botox/Dysport is available in injectable form. It is recommended that this treatment be repeated every 3-4 months.

Most common side effects of Botox injection

In general, Botox treatment was well tolerated by the large majority of patients and few people in the studies stopped participating because of side effects (4% in the Botox treated group and 1% in the placebo group). In both studies, side effects that were reported by more than 2% of people treated with Botox and more frequent than in patients treated with placebo included:

  • Headache
  • Facial loss of movement
  • Eyelid drooping
  • Lung inflammation
  • Neck pain
  • Muscle stiffness and weakness
  • Muscle pain and spasms
  • Pain at injection site
  • High blood pressure

Serious side effects

The spread of effect beyond the areas treated for approved uses at approved doses have not generally been reported.

Who should not take Botox for migraines

Botox is not for every patient. People should avoid Botox if they are allergic to any of the ingredients, have had an allergic reaction to other similar products or have a skin infection at the site where Botox will be injected. Caution should be exercised for people who have any disease that affects their muscles or nerves, those with breathing, swallowing or bleeding problems as well as those who have facial weakness such as drooping eyelids or recent facial surgery. It is not known whether it is safe to be pregnant or breast feed while using Botox.

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