The use of botulinum toxin injections has advanced tremendously over the last few years. Applications in cosmetic surgery and muscle spasticity disorder are now well recognized and are offered at a number of different centers all over the world. Its use has now been extended to treating migraines.
In October 2010, Botox® was FDA approved to treat migraines. It is the only FDA-approved, preventive treatment that is injected by a doctor every 12 weeks for adults with Chronic Migraine (15 or more headache days a month, each lasting 4 hours or more). Botox® prevents up to 9 headache days a month (vs up to 7 for placebo). Botox® therapy is not approved for adults with migraine who have 14 or fewer headache days a month. In this article we shall take a brief look at this new application of botox injections.
Botox injections work by paralyzing the nerves and blocking the flow of nerve signals, thus relaxing the muscles. It is produced by Clostridium botulinum, a bacterium. Its primary use is to relax the muscles around the eyes and other parts of the body, helping restore muscle tone and improving overall function.
Botox in migraine
Migraine is primarily mediated by the release of the neuro-chemical serotonin. Botox® does not have any effect on this, but studies have shown that it can still help reduce pain in patients suffering from migraine.
While this is exciting news, it is still under investigation and there does not appear to be a clear reason as to how it can help reduce migraine headaches. The recommendations from the studies is to inject the Botox® into the scalp at around 31 -39 different points in patients who have suffered There are a number of theories that have been postulated –
- Blocks the nerves from transmitting pain signals
- Relaxes the scalp muscles and may help reduce blood pressure within the brain
Even though research is still in early stages, there appears to be good evidence supporting its use particularly because it can help reduce the frequency of headaches and also improve the quality of life of patients.
Botox injections are recommended for chronic migraine suffers who have had headaches for more than 15 days in a month and in those who have not responded to different drug treatments. A condition called ‘analgesic overuse headache’, which is headache due to overuse of painkillers, also needs to be ruled out.
Treatments should be stopped if 2 cycles of Botox® injection treatments have failed, or the character of the migraine has changed and no longer meets the criteria of occurring on 15 days of a month.
FDA Approved Indication for Botox for Migraines
According to Allergan, Botox® (onabotulinumtoxinA) 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).
Botox® injections into the scalp may cause neck pain and allergic reactions, but these are rare.
The uses of Botox® are still growing and its effectiveness of treating migraines has been confirmed with its FDA approval. If you want your insurance to cover this treatment, it is important that your provider uses Botox® and not Botox® Cosmetic.
Botox is a trademark of Allergan Inc.;