Injections into the head to prevent migraine
What is Botox?
Botox is used as a treatment for chronic migraine in the UK.
Botox (botulinum toxin type A) is a type of nerve toxin that paralyses muscles. It comes from a bacterium known as Clostridium botulinum. It was discovered as effective for people with chronic migraine while being used for cosmetics treatment. It was found that people who had Botox experienced fewer headaches.
When is Botox used?
Botox is approved for use on the NHS for the treatment of chronic migraine in adults. Chronic migraine is defined as having at least 15 headache days a month, with at least eight of those featuring migraine symptoms.
It is not an effective treatment for other types of headache including episodic migraine (headache on fewer than 15 days a month), tension-type headache and cluster headache.
Botulinum toxin is used to treat other conditions such as hemifacial spasm, cervical dystonia, cerebral palsy, bladder pain, lower back pain, neuropathic pain and stroke.
In England and Wales, the National Institute of Health and Care Excellence (NICE) recommends the use of Botox for people with chronic migraine who:
- have failed at least three preventive treatments
- have been appropriately managed for medication overuse headache
In Scotland, the Scottish Medicines Consortium (SMC) approved Botox for chronic migraine where people have failed to respond to three oral preventive treatments and any medication overuse has been appropriately managed.
In Northern Ireland, the Department of Health endorsed the NICE appraisal approving Botox for chronic migraine in 2012.
How does Botox work?
It’s not clear why Botox is effective in migraine. However, doctors think it works by blocking chemicals called neurotransmitters that carry pain signals from within your brain.
Will it work for me?
Botox aims to reduce how often you have migraine attacks and how severe they are.
Most people have at least two treatment cycles before deciding if Botox is effective. A good response to Botox is usually a 30-50% reduction in how many headaches you have. Doctors will also consider any improvements in your quality of life. Some people notice an improvement in their quality of life with Botox even if they don’t have a big reduction in headache days.
How is Botox given?
The guidelines recommend Botox is given as a series of between 31 and 39 small injections. These are given under the skin or into the muscles in and around the head of the forehead, above the ears, and into the neck. The person doing your treatment will have been trained to provide Botox for chronic migraine.
Injections are given every 12 weeks. Botox is usually given until your migraine has changed to episodic migraine for three months in a row, or that there is significant improvement in disability using quality of life questionnaires. If Botox doesn’t improve your migraine enough it may be stopped.
What are the side effects of Botox?
Generally, Botox is well-tolerated. The most common side effects include neck pain, muscular weakness and drooping of the eyelid. These side effects are temporary because the treatment wears off over time.
How do I access Botox?
Botox is only available on the NHS for people with chronic migraine who have tried at least three other preventive treatments. It is currently only available via a specialist such as a headache specialist or consultant neurologist.
If you think you are eligible for Botox and would like to considered for treatment you can ask for a referral to a specialist. The specialist will assess your history and symptoms to make sure Botox is an appropriate treatment option for you. You should be asked to keep a headache diary to monitor the effectiveness of the treatment.
If Botox doesn’t work for you or stops working your specialist will discuss other treatment options with you.