Can botox can help reduce migraine attacks?

BOTOX® Chronic Migraine

Can botox can help reduce migraine attacks?

IMPORTANT SAFETY INFORMATION

BOTOX® may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX®:

  • Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months
  • Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing

There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX® has been used at the recommended dose to treat chronic migraine.

BOTOX® may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking BOTOX®. If this happens, do not drive a car, operate machinery, or do other dangerous activities.

Do not receive BOTOX® if you: are allergic to any of its ingredients in BOTOX® (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.

The dose of BOTOX® is not the same as, or comparable to, another botulinum toxin product.

Serious and/or immediate allergic reactions have been reported including itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Get medical help right away if you experience symptoms; further injection of BOTOX® should be discontinued.

Tell your doctor about all your muscle or nerve conditions such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including difficulty swallowing and difficulty breathing from typical doses of BOTOX®.

Tell your doctor about all your medical conditions, including if you: have or have had bleeding problems; have plans to have surgery; had surgery on your face; weakness of forehead muscles; trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® can harm your unborn baby); are breastfeeding or plan to (it is not known if BOTOX® passes into breast milk).

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using BOTOX® with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX® in the past.

Tell your doctor if you received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take aspirin- products or blood thinners.

Other side effects of BOTOX® include: dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, dry eyes; and drooping eyebrows.

For more information refer to the Medication Guide or talk with your doctor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Indication BOTOX® is a prescription medicine that is injected to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years or older.

It is not known whether BOTOX® is safe or effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).

Please see BOTOX® full Product Information including Boxed Warning and Medication Guide.

Program Terms, Conditions, and Eligibility Criteria: 1. This offer is good for use only with a valid prescription for BOTOX® (onabotulinumtoxinA). 2.  insurance coverage, each patient can be reimbursed up to $1000 per treatment with a maximum savings limit of $4000 per year. Patient out-of-pocket expense may vary. 3. This offer is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this offer if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. This offer is not valid for cash-paying patients. 4. This offer is valid for up to 4 treatments over a 12-month period. 5. Offer is valid only for BOTOX® and BOTOX® treatment-related costs not covered by insurance. 6. A BOTOX® Savings Program check will be provided upon approval of a claim. The claim must be submitted with treatment details from an Explanation of Benefits (EOB) or a Specialty Pharmacy (SP) receipt. (If the BOTOX® prescription was filled by a Specialty Pharmacy, both EOB and SP details must be provided.) All claims must be submitted within 120 days of treatment date. You may be required to provide a copy of your EOB or SP receipt for your claim to be approved. 7. A BOTOX® Savings Program check may be sent either directly to you or to your selected healthcare provider who provided treatment. For payment to be made directly to your healthcare provider, you must authorize an assignment of benefit during each claim submission. You are not obligated to assign your BOTOX® Savings Program benefit to your healthcare provider to participate in the program. 8. Allergan® reserves the right to rescind, revoke, or amend this offer without notice. 9. Offer good only in the USA, including Puerto Rico, at participating retail locations. 10. Void where prohibited by law, taxed, or restricted. 11. This offer is not health insurance. 12. By participating in the BOTOX® Savings Program, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.

For questions about this program, please call 1-800-44-BOTOX.

Source: https://www.botoxchronicmigraine.com/chronic-migraine-treatment

YOU GOT THIS

Can botox can help reduce migraine attacks?

IMPORTANT SAFETY INFORMATION

BOTOX® may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX®:

  • Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months
  • Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing

There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX® has been used at the recommended dose to treat chronic migraine.

BOTOX® may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking BOTOX®. If this happens, do not drive a car, operate machinery, or do other dangerous activities.

Do not receive BOTOX® if you: are allergic to any of its ingredients in BOTOX® (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.

The dose of BOTOX® is not the same as, or comparable to, another botulinum toxin product.

Serious and/or immediate allergic reactions have been reported including itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Get medical help right away if you experience symptoms; further injection of BOTOX® should be discontinued.

Tell your doctor about all your muscle or nerve conditions such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including difficulty swallowing and difficulty breathing from typical doses of BOTOX®.

Tell your doctor about all your medical conditions, including if you: have or have had bleeding problems; have plans to have surgery; had surgery on your face; weakness of forehead muscles; trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® can harm your unborn baby); are breastfeeding or plan to (it is not known if BOTOX® passes into breast milk).

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using BOTOX® with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX® in the past.

Tell your doctor if you received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take aspirin- products or blood thinners.

Other side effects of BOTOX® include: dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, dry eyes; and drooping eyebrows.

For more information refer to the Medication Guide or talk with your doctor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Indication BOTOX® is a prescription medicine that is injected to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years or older.

It is not known whether BOTOX® is safe or effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).

Please see BOTOX® full Product Information including Boxed Warning and Medication Guide.

Program Terms, Conditions, and Eligibility Criteria: 1. This offer is good for use only with a valid prescription for BOTOX® (onabotulinumtoxinA). 2.  insurance coverage, each patient can be reimbursed up to $1000 per treatment with a maximum savings limit of $4000 per year. Patient out-of-pocket expense may vary. 3. This offer is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this offer if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. This offer is not valid for cash-paying patients. 4. This offer is valid for up to 4 treatments over a 12-month period. 5. Offer is valid only for BOTOX® and BOTOX® treatment-related costs not covered by insurance. 6. A BOTOX® Savings Program check will be provided upon approval of a claim. The claim must be submitted with treatment details from an Explanation of Benefits (EOB) or a Specialty Pharmacy (SP) receipt. (If the BOTOX® prescription was filled by a Specialty Pharmacy, both EOB and SP details must be provided.) All claims must be submitted within 120 days of treatment date. You may be required to provide a copy of your EOB or SP receipt for your claim to be approved. 7. A BOTOX® Savings Program check may be sent either directly to you or to your selected healthcare provider who provided treatment. For payment to be made directly to your healthcare provider, you must authorize an assignment of benefit during each claim submission. You are not obligated to assign your BOTOX® Savings Program benefit to your healthcare provider to participate in the program. 8. Allergan® reserves the right to rescind, revoke, or amend this offer without notice. 9. Offer good only in the USA, including Puerto Rico, at participating retail locations. 10. Void where prohibited by law, taxed, or restricted. 11. This offer is not health insurance. 12. By participating in the BOTOX® Savings Program, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.

For questions about this program, please call 1-800-44-BOTOX.

Source: https://www.botoxchronicmigraine.com/

Does Botox reduce the frequency of chronic migraine? – Harvard Health Blog – Harvard Health Publishing

Can botox can help reduce migraine attacks?

Doesn’t it seem Botox is showing up everywhere as a medical treatment? Botox is a brand of botulinum neurotoxin (BoNT), a protein substance originally derived from the bacterium Clostridium botulinum. In its original form it was the toxin responsible for botulism, the paralyzing illness often caused by eating contaminated food.

BoNT is now used to treat a number of medical conditions including muscle spasms, excessive sweating, overactive bladder, and some eye muscle conditions. However, one of its most common uses is in the preventive treatment of chronic migraine.

Chronic migraine, defined as headache occurring more than 15 days a month for more than three months, is rare, affecting only about 3% of the migraine population.

Nonetheless, since migraine itself is so common, this condition ends up affecting a large number of people and can be extremely debilitating.

A recent meta-analysis pooled the results of multiple prior studies to investigate the usefulness of Botox, a brand of BoNT, in reducing the frequency of chronic migraine. The results suggested that there was benefit from this treatment; it not only improved quality of life and significantly reduced the frequency of chronic migraine headaches, but did so with few and mild side effects.

How might BoNT work to prevent chronic migraine?

Botox was introduced for treatment of chronic migraine in 2000, after some people receiving injections for cosmetic treatment of facial lines reported improvement of headaches.

Initial studies after that observation produced conflicting results.

Then in 2010, two large studies showed enough benefit (reduction in headache days and improved quality of life) that the FDA approved this treatment for chronic migraine.

Botulinum neurotoxin is taken up into nerves, where it may modify the release of neurotransmitters, chemicals that carry signals between brain cells. This is the original mechanism responsible for the paralysis in BoNT poisoning.

However, this same process in other nerves may interrupt pain production by blocking the release of pain-producing chemicals such as substance P and calcitonin gene-related peptide (CGRP).

Although not yet proven, this process could lead to a turning-down of pain processes inside the brain that may be responsible for chronic migraine.

Although this mechanism can reduce headache frequency and severity, it does not seem to change the underlying migraine condition.

What are the risks of this treatment?

Theoretically, the spread of BoNT from the site of injection to other areas could result in muscle weakness or paralysis, and doctors usually avoid using BoNT in people with muscle weakness conditions. In practice, however, body-wide reactions or side effects are rare.

Mild injection-related irritation is sometimes reported. At times, temporary eyelid drooping or a change in facial expression resulting from the loss of forehead lines can be seen. These complications can be avoided by moving subsequent injections to a different location. People typically have no restrictions after their injections, and they may return to work or normal activities.

Who would be a candidate for Botox and who wouldn’t?

Since its introduction Botox has become an accepted treatment for chronic migraine when other standard treatments have failed. Botox can help people feel and function better with fewer missed days of work, and the treatments are often covered by health insurance plans.

Botox is not typically used in people who have 14 or fewer migraine headaches per month. However, it is sometimes used “off label” (outside FDA approval) for other forms of chronic headache, such as chronic tension headache.

Where does Botox fit relative to other treatments to prevent migraine?

A comprehensive migraine management plan consists of maintaining a healthy lifestyle, avoiding migraine triggers as much as possible, and using over-the-counter and prescription abortive medications (to stop a migraine already in progress), as needed.

In chronic migraine, standard treatments, including daily prescription preventive medications alone or in combination, are usually tried before Botox.

A disadvantage of Botox is that it must be administered through injection by a medical provider every three months in order to maintain the effect.

In addition, those on Botox may need to continue taking their previous prescription migraine medications for optimal results.

Nonetheless, Botox has become a common treatment in headache centers in the US. Botox injections are well-tolerated, beneficial, and appear to be safe for long-term management of chronic migraine.

Source: https://www.health.harvard.edu/blog/does-botox-reduce-the-frequency-of-chronic-migraine-2019091817772

I Tried Botox for My Chronic Migraines and It Completely Changed My Life

Can botox can help reduce migraine attacks?

I love talking about migraines.

I don't do it to be a downer; I do it because talking about dealing with my chronic migraines may lead to hearing tips from another fellow sufferer, and I've tried nearly everything at this point.

I've dealt with migraines for almost two decades, and as anyone who deals with them knows, having a variety of remedies in your toolbox is crucial when the pain hits.

I've typically managed my pain through a combination of medication (both to combat migraines when they hit and to prevent them from happening), home remedies, and a grin-and-bear-it attitude. However, when my migraines increased in both regularity and intensity, I began to research another option: Botox for migraines.

Botox is said to decrease the frequency of migraine days by an average of 50 percent for those who suffer chronically (people who experience 15 or more headache days per month).

After going through hell with my insurance to get approval, I scheduled an appointment with New York City neurologist and pain-management specialist Risa Ravitz.

She was kind enough to speak with me about the wonders of Botox while we did my first procedure in June 2017.

Much other fillers, Botox is slowly metabolized in the system, so for it to remain effective, patients have to get the procedure every three months or so (however, as Ravitz told me during a recent visit, you can't get it done too frequently or your body will develop antibodies). I've now had four additional rounds of Botox since my initial procedure and have learned a lot about how my body reacts to it. Read on for both Ravitz's insight and information about my experience with five rounds of Botox.

Let's talk about migraines — namely, chronic migraines.

First of all, for those who aren't familiar with migraines, they're different from headaches.

Headaches are unpleasant, too, but are typically less severe than migraines and don't usually present with other symptoms besides the pressure and aching in the head.

Migraines, on the other hand, can be much more intense and often come with nausea, seeing spots, vomiting, extreme fatigue, sensitivity to light and sound, and more.

They affect 39 million folks in the U.S., 4 million of whom deal with daily pain. Chronic migraines can severely inhibit daily life, and when I started to feel my bad days were outnumbering my good, I knew I needed to find a solution.

Botox had been suggested to me multiple times before by friends, family, and doctors, and though it took quite a while to get it approved by insurance and find a provider I trusted, my migraines were making it hard to live a normal life, so I decided to try it out.

How is Botox for migraines different from cosmetic Botox?

The Botox used for migraines and the Botox used for cosmetic procedures is actually exactly the same. “Basically, young and middle-aged women were getting [Botox] for cosmetic purposes, and that’s the most common person that has migraines, and that’s how they figured out it was helpful,” Ravitz tells me.

Women were getting Botox for aesthetic reasons and happened to notice relief from their migraine symptoms, and doctors began looking into it as a direct treatment.

In fact, women are disproportionately affected by migraines — about 85 percent of chronic-migraine sufferers are women, and the condition affects 28 million in just the U.S.

The only difference between the two procedures is that with Botox for migraines, they may do a few more shots in areas where the pain is experienced.

Personally, I usually get between 30 and 40 shots, concentrated mostly on the right side of my head where the pain occurs, at the base of my skull, and on my neck and shoulders, where I tend to hold tension, as doing so can cause a migraine.

Botox for migraines can have the same aesthetic effect that cosmetic Botox has, which kills two birds with one stone for people who may desire that effect. “We do it along wrinkle lines and keep it symmetrical,” says Ravitz, which explains the erasing of lines and temporary plumping of wrinkles.

Source: https://www.allure.com/story/botox-injections-for-migraines

Botox for Migraine

Can botox can help reduce migraine attacks?

We’ve all heard of Botox, responsible for generations of smooth foreheads in Hollywood. But Botox has also brought relief to many people who suffer from chronic medical conditions. In 2010, Botox was approved for use with chronic migraine, and many patients are reporting success. What do you need to know before considering it?

What Type of Headache Responds Best to Botox?

Botox is only FDA-approved for chronic migraines, which means headache on 15 or more days a month.  “The more frequent the headaches, the better the patient does with Botox,” says Dr. Andrew Blumenfeld, Director, The Headache Center of Southern California. Botox is not recommended for patients who experience fewer than 15 headache days a month.

What is Botox?

Botox is a form of botulinum toxin, a neurotoxin produced by the bacteria that causes botulism. When the Botox botulinum toxin is purified and used in tiny doses in specific areas, it temporarily reduces muscle contractions for approximately 3 months.

How Does Botox Work?

Botox is injected around pain fibers that are involved in headaches. Botox enters the nerve endings around where it is injected and blocks the release of chemicals involved in pain transmission. This prevents activation of pain networks in the brain.

Botox prevents migraine headaches before they start, but takes time to work. “I look to the second and third treatments to maximize effects,” says Dr. Andrew Blumenfeld. “Patients see in

creasing benefit with an increase in the number of treatment cycles.” One treatment lasts for 10-12 weeks, and patients reported that two Botox treatments reduced the number of headache days by approximately 50%.

Who Uses Botox?

The FDA approves the use of Botox to treat chronic migraine in adults who are age 18 or over.  Botox is considered an “off-label” treatment if it’s used for children or adolescents. This means that a doctor can prescribe it, but insurance companies might not pay for it.

Finding a Doctor Who Treats Migraine with Botox

If you want to try Botox for migraine, you should look for a headache specialist or neurologist. We recommend using your insurance’s doctor listing, Yelp, or the American Migraine Foundation’s doctor database.

Dr. Laura Banks, neurologist at Natividad Medical Center, suggests asking prospective doctors where they learned to give Botox, and how many times they’ve given it. “You’re looking for a lot of experience,” she says. Dr. Andrew Blumenfeld suggests asking doctors how many injections they will give, and where they will give them.

Getting Botox Treatment Paid for by Insurance

In general, the FDA-recommended dosage of 155 units costs between $300 to $600 for each treatment. Because Botox is FDA approved for chronic migraine, it’s covered by most plans, including Medicare and Medicaid. Allergan offers a “Botox Savings Card,” which offers patients reduced fees.

Please note that before your insurance company will approve Botox as a treatment for your chronic migraine, you typically must have tried and failed to respond to two other preventative treatments. These might include anti-seizure medications, antidepressants, or blood pressure medications that are typically used to prevent migraine.

What is Treatment ?

When you receive your first Botox treatment, expect the appointment to take about 20 minutes. The doctor uses a very small needle that feels a pinprick. He or she injects small amounts of Botox into shallow muscles in the skin. Each treatment typically involves 31 injections in seven key areas of the head and neck.

The most common side effect from the Botox shots is a sore neck, and we recommend using an ice pack to reduce the discomfort.

It can take up to six months to see the maximum benefit from Botox. In the meantime, you can continue your regular medications with no risk of a drug interaction.

Source: https://americanmigrainefoundation.org/resource-library/botox-for-migraine/

Botox

Can botox can help reduce migraine attacks?

Botox® (onabotulinum toxin A) was licensed specifically for the treatment of chronic migraine in July 2010 by the Medicines and Healthcare products Regulatory Agency (MHRA).

Botox® has not been shown to be effective for any other headache type (e.g. episodic migraine, tension-type headache, cluster headache) as yet.

The information below outlines the evidence for the use of botulinum toxin in headache.

What is botulinum toxin?

Botulism – paralysis of muscles caused by high doses of botulinum toxin – was first described in 1817. The responsible bacterium, Clostridium botulinum, was not isolated until 1895. Seven different subtypes of botulinum toxin (A-G) are known.

A highly dilute preparation of botulinum toxin type A (Botox®) was introduced in clinical practice in the 1970s and 1980s to treat squint and blepharospasm. Since then it has found uses in other areas of medicine including dystonia (including writer’s cramp), post-stroke spasticity, and hyperhidrosis.

Other botulinum toxin preparations are available, both of type A (Dysport and Xeomin) and type B (Neurobloc or Myobloc), but these have never been tested in headache disorders.

Botulinum toxin and headache

In the mid-1990s a number of people reported improvement in headaches in patients receiving botulinum toxin for other reasons.

Well-conducted clinical trials of botulinum toxin in various types of headache followed, but the results were disappointing, with no difference over placebo being found in tension-type headache, episodic migraine, and undifferentiated chronic headache.

Detailed analysis of the results suggested, however, that there might be a subgroup of patients with chronic migraine who could benefit, and further trials were undertaken.

Botox® in chronic migraine: the PREEMPT trials

Two Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials recruited 1384 patients with chronic migraine, and randomised them to treatment with Botox® or placebo. These patients were suffering on average 20 days of headache each month, of which 18 were moderate or severe.

Those randomised to Botox® received fixed-site, fixed dose injections every 12 weeks over 56 weeks. These injections covered seven specific areas of the head and neck, with a total dose of between 155-195 units.

At six months, after two cycles of treatment, those treated with Botox® had on average eight less days of headache each month. After 12 months, 70% of those treated had ≤50% the number of headaches that they had done originally. Botox® was well-tolerated, the commonest side effects being neck pain (6.

7%), muscular weakness (5.5%), and drooping of the eyelid (3.3%). No serious irreversible side effects have ever been reported in trials of Botox® in headache.

How does botulinum toxin work in chronic migraine?

The simple answer is that we don’t know fully.

A recent US study by Rami Burstein et al using animal models suggested that botulinum toxin inhibits pain in chronic migraine by reducing the expression of certain pain pathways involving nerve cells in the trigeminovascular system. The trigeminovascular system is a sensory pathway thought to play a key role in the headache phase of a migraine attack.

Un many of the other conditions in which it is used, it is not thought to work by relaxing overactive muscles. Botulinum toxin has been shown to reduce pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain, and bladder pain.

More research into the mechanism of action of botulinum toxin will hopefully shed light into all the pathways that it acts upon.

Is Botox® right for me?

Only patients with chronic migraine are eligible for treatment with Botox®. Chronic migraine is defined as headaches occurring on 15 or more days each month, at least half of which have migrainous features.

There are, however, other treatments available to patients with chronic migraine, and it is important that patients have an informed discussion of their headaches and the options for treatment with a practitioner experienced in the diagnosis and management of headaches before a decision to use Botox® is taken.

Who can inject Botox® for chronic migraine?

At present the use of Botox® is restricted to a few specialist headache centres, but as time goes on there should be increasing numbers of trained injectors available.

In all cases, however, you should ensure that the person injecting has received appropriate training, both in the diagnosis and management of chronic migraine, and in the delivery of Botox® according to the proven PREEMPT schedule.

Please note that the referral process differs for each location.  In the first instance, patients who are struggling to manage their symptoms should discuss this with their general practitioner (GP) and if appropriate, seek referral to a specialist with an interest in headache disorders.  Read more about seeking medical advice.

On visiting a migraine clinic a detailed history of the patient’s condition will be taken, including symptoms, frequency of attacks and any medication tried in the past or currently taking.  Keeping a diary can help with this.

Availability of Botox® for treating chronic migraine on the NHS

The National Institute for Health and Care Excellence (NICE) issued guidance in June 2012 recommending Botox® is made available on the NHS as a preventive treatment option for adult patients with chronic migraine – this applies to NHS settings in England and Wales.

Following the NICE guidance, local NHS healthcare providers in England and Wales had three months to ensure the funding and resources were in place for suitable patients to access the treatment following recommendation by a suitably qualified health professional.

  This time frame has now elapsed and the treatment should be available locally on the NHS for those meeting the criteria.

  Access to treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you, is a patient right enshrined in the NHS Constitution.

In February 2017 the Scottish Medicines Consortium (SMC) approved Botox® for the prophylaxis of headaches in adults with chronic migraine for restricted use by NHS Scotland. The decision was made after a resubmission of evidence in 2016. The SMC had previously turned down submissions in 2011 and 2013.

If your health professional has recommended that you are suitable for this treatment, but you or your health professional are having difficulty accessing the funding or resources for you to receive Botox® from your local NHS healthcare provider, then The Migraine Trust’s Advocacy Service may be able to provide further support.

For further information please read:

Source: https://www.migrainetrust.org/living-with-migraine/treatments/botox/

Why Botox Can Help Prevent Migraines

Can botox can help reduce migraine attacks?

Botox (onabotulinumtoxin A) is an injectable muscle paralytic drug used for migraine prevention. It had been approved as a medical treatment for severe muscle rigidity and for cosmetic use to smooth out wrinkles before it was approved by the U.S. Food and Drug Administration (FDA) in 2010 for the prevention of chronic migraines.

When used for migraine prevention, Botox injections are scheduled about every three months because the effects are not permanent. With time, most people who experience a decrease in migraine frequency and severity with Botox are able to have less frequent injections.

Botox is derived from a toxin produced by the bacteria Clostridium botulinum. The toxin temporarily blocks the release of chemicals involved in nerve signaling, decreasing muscle activity.

Accidentally ingesting the toxin through spoiled food can cause an illness known as botulism, which produces dangerous muscle paralysis throughout the body. This can be fatal because it may interfere with breathing and heart function long before the effects of the toxin wear off.

But when used properly for therapeutic or cosmetic purposes, botulinum toxin is isolated and placed into a liquid solution for a carefully targeted injection that only paralyzes the injected muscles, greatly reducing the concerns associated with systemic effects.

The muscle paralysis produced by Botox treatments lasts for a few months, so repeated injections may be necessary.

The understanding of how Botox may help migraines is still developing. However, the way Botox works as a migraine preventive has nothing to do with its effect on muscle. Instead, it’s believed to work at nociceptive (pain) recepetors via a mechanism inhibiting release of inflammatory mediators and preventing central sensitization.

Some evidence suggests that botulinum toxin may also have an impact on neurotransmitter release in the brain and on the brain's pain receptors.

For those who suffer from chronic migraine, which is defined as 15 or more days of headache per month for at least three consecutive months, studies suggest that Botox has a small to moderate positive effect when it comes to preventing migraines. There have been many small trials examining the effect of Botox injections on migraine frequency and severity.

For example, a study in Spain included 69 participants who had chronic migraines. Each received an average of two botulinum toxin injections. The study authors reported that participants experienced a significant reduction in their pain intensity and number of headache days over the 16-month duration of the study.

A larger review included data from 28 trials, including a total of 4190 participants. The researchers only included randomized double-blind controlled trials, a standard that is considered the most reliable and unbiased method of testing a medication. Participants received various brands of botulinum toxin injections.

The researchers who investigated this large compilation of studies reported that participants who received botulinum toxin injections experienced an average reduction of three headache days per month, while participants who received a placebo injection experienced an average of one less headache day per month, suggesting that botulinum toxin has an impact.

So far, the science and evidence regarding the effectiveness of Botox injections for chronic migraine prevention is promising, but not overwhelmingly so.

Botox injection for chronic migraine prevention should take no longer than five to 15 minutes. During the procedure, several sites around the head and neck are injected. While you may feel a slight burning or pinprick sensation with each injection, the discomfort is short-lived, and most people tolerate it well.

Illustration by Cindy Chung, Verywell

When you undergo a Botox treatment, your doctor will ly place at least 31 injections into seven key muscles of the head and neck. These seven areas of muscles include:

  • Corrugator: Located at the inner end of each eyebrow
  • Procerus: Located between the eyebrows
  • Frontalis: Located at the front of the head (forehead)
  • Temporalis: Located on each side of the skull (the muscle used for chewing)
  • Occipitalis: Located near the back of the skull
  • Cervical paraspinal muscle group: Located at the top and back of the neck surrounding the spine
  • Trapezius: Located at the upper back and back of the neck

Additional muscles may be injected depending on the location of your typical headaches.

The injections generally need to be repeated every 12 weeks. It usually takes more than one Botox treatment and can take up to six months to see a therapeutic benefit when Botox is used for migraine prevention.

Botox can produce side effects. It should always be injected by a trained professional. If your anatomy is asymmetric, or if the dose you receive is not exactly equal on your left and right sides, you may develop a slightly lopsided facial appearance for a few months until the medication starts to wear off.

Other side effects that can occur include:

  • Muscle weakness
  • Blepharoptosis (eye drooping)
  • Skin tightness
  • Paresthesia (unusual skin sensations)
  • Neck stiffness
  • Neck pain or soreness

Technically, Botox is a toxin, not an infection. But some people develop an immunity to the toxin, making it ineffective. You can develop this reaction whether you are getting Botox for muscle disease, cosmetic reasons, or migraine prevention.

There are also some rare, but potentially serious and life-threatening adverse events that can occur after a Botox injection. These effects may occur as a result of very high injection doses, unusual sensitivity to the medication, or to spreading of the medication to other areas beyond the injected muscle.

These adverse events may occur hours to weeks after injection and require immediate medical attention.

Get emergency medical attention if you experience any of the following:

  • Problems swallowing, speaking, or breathing
  • Loss of muscle strength
  • Double vision, blurry vision, inability to open one or both eyelids
  • A hoarse voice, slurred speech
  • Loss of bladder control

Keep in mind that Botox can be quite expensive. Many insurance companies require extensive documentation proving that other preventive migraine therapies have been ineffective before covering the cost of Botox. Some payers do not cover it all, regardless of the situation.

Treatment of chronic migraines focuses on a combination of behavioral interventions, such as trigger avoidance, and pharmacological treatments. Injections, such as Botox, muscle relaxants, and local anesthetics, as well as interventional surgical procedures, are growing in popularity.

Botox appears to provide some benefit in preventing chronic migraines. One of the advantages is that you can use Botox even if you continue to take medications for migraine treatment or prevention because they do not interact with each other.

Thanks for your feedback!

What are your concerns?

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  • Castrillo Sanz A, Morollón Sánchez-Mateos N, Simonet Hernández C, Fernández Rodríguez B, Cerdán Santacruz D, Mendoza Rodríguez A. Experience with botulinum toxin in chronic migraine. Neurologia. 2018 Oct;33(8):499-504. doi: 10.1016/j.nrl.2016.09.004. Epub 2016 Oct 21.

Source: https://www.verywellhealth.com/botox-for-migraine-prevention-1719865

Botox Injections for Migraines: How It Treats Migraine Headaches

Can botox can help reduce migraine attacks?

If you have been diagnosed with migraine and get migraine headaches often, you may wonder if there's anything you can do to prevent them.

OnabotulinumtoxinA, or Botox, was approved in 2010 for adults who get chronic migraines. That means you have both:

  • A history of migraine headaches
  • Headaches (including tension-type) on most days (15 or more) of the month of which 8 are migraine

It is not an approved treatment if you:

  • Get headaches 14 or fewer days each month
  • Have other types of headaches, cluster

Botox is a neurotoxin, a poison made by bacteria called Clostridium botulinums. It can cause a deadly reaction called botulism if you eat it in spoiled food because it blocks signals from your nerves and paralyzes your muscles.

But it's safe because the toxin isn't digested in your stomach and the dose is much smaller amount than you'd get in spoiled food.

Doctors found that shots of Botox can help smooth wrinkles because it relaxes muscles in the face. It also helps people who have tics and spasms because of a nerve disease cerebral palsy.

When people who had migraine headaches used Botox to treat their wrinkles, they told their doctors that their headaches were better. So doctors began to study it as a migraine pain treatment.

In a study of adults who get chronic migraine headaches, shots of Botox cut down the total number of days they had them or even other types of headaches. They also had more “crystal-clear” — pain-free — days each month, and they reported fewer days off work.

In another study, nearly half the people who took two rounds of Botox shots reported that the number of days they had a headache each month was cut in half. After five rounds of treatment, that increased to about 70% of the people.

Doctors think Botox works for migraine headaches because it blocks chemicals called neurotransmitters that carry pain signals from your brain. Botox is a roadblock in that pathway. It stops the chemicals before they get to the nerve endings around your head and neck.

You'll get several shots of Botox around your head and neck once every 12 weeks to dull or prevent migraine headaches.

You may need 30 to 40 shots in all, and you'll get an equal number on each side of your head. If you have migraine pain in one particular spot, you may need more shots there. You could see results 2 to 3 weeks after your first treatment.

You should only get this type of Botox treatment from a doctor who's trained to give these shots for chronic migraine headaches rather than for wrinkles or other cosmetic uses.

Neck pain and headache are the most common side effects for people who get chronic migraine headaches and use Botox.

It's rare, but you can have an allergic reaction to Botox. Signs of this can be hives, shortness of breath, or swelling in your lower legs. Although there's no confirmed case where Botox spread to other parts of the body, it is possible and could be deadly. The medication label includes this warning.

SOURCES:

Food and Drug Administration.

Khalil M. Journal of Headache and Pain. September 2014.

Gundersen Health System: “Headaches and Migraines.”

Aurora S. Acta Neurologica Scandinavica. January 2014.

Migraine Association of Ireland: “Botox for Migraine.”

MayoClinic: “Migraine.”

Help For Headaches, Ontario, Canada: “Botox Treatment for Migraine.”

© 2020 WebMD, LLC. All rights reserved. Botox Myths and Facts

Source: https://www.webmd.com/migraines-headaches/botox-migraines

healthnewschronicle.com