About botox for chronic migraine
Botulinum toxin works on migraine by blocking the release of pain-signalling chemicals from nerve endings in the muscles of the head and neck, which reduces the sensitisation of the migraine pathways. It does not act by relaxing muscle in the way it does for wrinkles, and the doses and injection points are different.
In clinical trials, treatment reduced headache days by around eight to nine a month, compared with six to seven on placebo, and about half of patients halve their headache days. At Cervino, injections are given by Dr Raga Qasem, a consultant neurologist with a specialist interest in headache disorders.
Symptoms we assess
Botox may be right for you if:
- You have headache on 15 or more days a month
- At least eight of those days have migraine features
- This has been the pattern for more than three months
- You have tried at least two or three preventive medications without enough benefit or with side effects
- You want a treatment that does not involve a daily tablet
- Medication overuse headache has been addressed or is being addressed alongside
How we diagnose it
Before treatment the consultant confirms the diagnosis of chronic migraine from your history and headache diary, checks that other headache types are not the main problem, reviews what preventives you have tried and at what dose, and discusses the alternatives, including the CGRP monoclonal antibody injections. A headache diary for the month before and the months after treatment is the measure of whether it is working.
Treatment and follow-up
Treatment follows the standard PREEMPT protocol: 31 small injections across the forehead, temples, back of the head, neck and shoulders, taking about 15 minutes. The injections sting briefly. You can drive and return to normal activities straight after. Benefit builds over the following weeks and the cycle is repeated every 12 weeks.
Two cycles are usually needed before the effect can be judged. If headache days have fallen by 30 to 50 per cent or more, treatment continues; if there is no benefit after two or three cycles it is stopped and another option chosen. Some patients can lengthen the interval or stop after a period of good control.
Side effects are mostly mild and local: bruising, neck ache, and occasionally temporary drooping of an eyebrow or eyelid. Serious side effects are rare. Botulinum toxin can be combined with acute migraine treatments and, in some cases, with other preventives.
When to see a GP, and when to see a consultant
Botox for migraine is a consultant treatment. Ask your GP for a neurology referral if your headache pattern fits chronic migraine and preventive tablets have not helped. Bring a headache diary and a list of the preventives you have tried.
