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Botox as a Treatment of Migraine

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Botulinum toxin has added wonders in the healthcare industry by treating various cosmetic disorders. Botox is also used to prevent chronic migraines nowadays.

Written by

Dr. Ruchika Raj

Medically reviewed by

Dr. Abhishek Juneja

Published At August 16, 2022
Reviewed AtJanuary 22, 2024

Introduction:

Botox or Botulinum toxin is a type of neurotoxin (nerve toxin) derived from the bacteria Clostridium botulinum. Botulinum toxin has seven variants of neurotoxins, out of which Type A and Type B variants are approved for clinical use. It sounds strange that the same toxin that causes botulism disease has been proven to be effective for clinical purposes when used in adequate doses. Botulinum toxin type A is now widely used by skin specialists and cosmetic surgeons.

Migraine has become one of the most common problems affecting daily life activities among the population nowadays. Because of a lack of awareness about the severity of headaches, many people with migraine either try to get rid of it using self medications or home remedies or just ignore it, taking it as a bad day.

What Is Chronic Migraine?

Frequent headaches of around more than 15 days a month have been termed a ‘chronic migraine' by the international classification of headache disorders (ICHD). Few migraine prescription medications are Ergotamine, Zolmitriptan, and Rizatriptan.

What Are Types of Migraine?

  • Migraine With Aura: It is called a classical headache with signs of aura, including sensory disturbances like sensitivity to light, sound, blurred vision, and tingling sensations. These symptoms get reversed as the attack episode lasts.

  • Migraine Without Aura: It is a mild to moderate headache without signs of aura (sensory disturbances)

What is the Prevalence of Migraine?

Migraine is more common among females than males.

What are the Symptoms of Chronic Migraine?

  • Frequent headaches with severe pain (Mostly half side headaches).

  • Vomiting sensation.

  • Sensitivity from light.

  • Sensitivity to sound.

  • Stomach upset.

  • Dizziness.

  • Headache lasting more than 5 to 72 hours.

  • Blurred vision.

How Does Botox Work for Migraines?

  • Botox is supposed to have muscle-relaxing properties similar to muscle relaxant drugs and pain reduction mechanisms similar to analgesics.

  • After various research, the following mechanism was believed to cause a reduction in pain intensity in migraine using botox treatment:

Botox Work for Migraines

What Are the Clinical Research Done for the Efficacy of Botox for Migraines?

Various researches have been done in the medical field about the effectiveness of botox in cases of migraine. After several clinical trials, onabotulinum toxin A was the first toxin to be released which was used to control pain intensities in chronic migraine. Clinical studies of other botox toxins like Abobotulinum toxin A and Incobotulinum toxin were also done, and these botox toxins were least effective in the reduction of pain in the episodic migraines of mild to moderate intensity. Onabotulinum toxin A is the only botulinum toxin that is approved for the treatment of chronic migraine (migraine with severe pain intensity).

What Are the Doses of Botox Injections?

  • Onabotulinum toxin A diluted with 2 ml of saline to make a 5 MU/0.1 ml dose for each injection site for the treatment of chronic migraine.

By Which Route Botox Injections Are Given?

Botox injections are given through the intramuscular route (IM) or subcutaneous route (SC).

What Are the Injection Sites of Botox for Migraine?

There are 31 fixed injection sites, including pain injection sites. 5 MU (milliunits) of Onabotulinum toxin A is injected intramuscularly (IM) at each injection site in the following muscles:

  • Frontalis (20 MU at four sites)

  • Corrugators supercilii (10 MU at two sites)

  • Procerus (5 MU at one site)

  • Occipitalis (30 MU at six sites)

  • Temporalis ( 40 MU at eight sites)

  • Trapezius (30 MU at six sites)

  • Cervical paraspinal muscle (20 MU at four sites)

  • In addition, 40 MU can be given at pain sites

(Maximum of 195 MU dose can be given in total)

How Much Is the Treatment Interval Time for Onabotulinum Toxin Injections?

Recommended treatment interval of every 12 weeks is fixed for Onabotulinum toxin A injections for the management of chronic migraine as injections at shorter time intervals can lead to the formation of antibodies against the botulinum toxin resulting in treatment failure.

What Is the Duration of Action of Onabotulinum A Toxin Injection?

The exact duration of reduction of pain (analgesic action) of Onabotulinum toxin A is still unknown but is believed to be similar to that of muscle relaxants.

Is Botox Treatment For Migraine Safe?

There are very rare systemic adverse effects of botox toxin reported till now.

Some rare injection-related adverse events have been reported like:

  • Pain on the injection site.

  • Drooping of the upper eyelid.

  • Muscle weakness.

  • Neck pain.

  • Shoulder pain.

Any such adverse events, if reported while the therapy, treatment can be postponed or discontinued based on the patient's decision.

Who Should Not Take Botox Treatment?

Botox treatment is contra-indicated in person with:

  • Muscle disorders like myasthenia gravis.

  • Breastfeeding mothers.

  • Pregnant females.

  • Patient with a previous history of eye surgery.

  • Children.

  • Patients allergic to Botox toxin (patch test should be done before the treatment).

  • Patients with systemic infections.

Is Botox Injection Tolerable?

The Onabotulinum toxin A injection for the treatment of migraine is safe and tolerable.

Conclusion:

Various clinical trials have been done and studied to know the effectiveness of botox for the prevention of migraine. Onabotulinum toxin A was proven to be most useful in the reduction and management of severe pain in chronic migraine. Botox treatment for migraine is helpful in the reduction of severe headache episodes disturbing daily life activities. Onabotulinum toxin A injections for migraine have been beneficial for many people and have improved their quality of life. Botox toxin is used by many doctors currently for cosmetic treatment, skin treatment, and as therapy for reduction or prevention of pain in chronic migraine. Although Onabotulinum toxin A is effective in the case of migraine, further clinical studies and research are still needed to understand the complete mechanism behind the reduction of pain by botulinum toxin injections for chronic migraine.

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Dr. Abhishek Juneja
Dr. Abhishek Juneja

Neurology

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