Botox Injections For Migraines

Introduction

At times, headaches can be quite severe and have accompanying symptoms which can cause them to be classified as migraines. 

Migraines are fairly common and can be debilitating and interfere significantly with your normal life. Some people might find that they are unable to even carry out basic daily activities or work. Fortunately, there are several treatments which are available to prevent and treat migraines.

Several medications have been developed to prevent migraines, these are usually prescribed to people who have chronic migraines. If you only have a few episodes of migraines, your doctor might prescribe an abortive medication which will stop the migraine. These medications are only taken as needed whilst preventative medication needs to be taken every day.

One such preventative treatment which has been developed is botox injections. One might associate Botox with wrinkles and improving facial aesthetics, but they have also been established as an effective treatment for migraines. In this article, we will explain what you can expect from botox treatments and describe any side effects you might experience. 

Understanding migraines

Even though migraines are fairly common, the exact causes are not yet understood. There are a variety of triggers which have been identified and different people have different triggers. Once triggered, migraines can last for a few hours or even a few days/weeks. There may be other associated symptoms such as fatigue, nausea, vomiting, trouble concentrating, visual disturbances etc. These symptoms usually occur before or during the migraine attack and are known as aura.¹

It is thought that migraines occur due to an imbalance in the chemicals in your brain, so most medication aims to correct this imbalance.² At first, your healthcare provider might try to help your migraines using traditional medication such as beta-blockers, SSRI (selective serotonin reuptake inhibitors) or SNRI (serotonin and norepinephrine reuptake inhibitors). Although these medications might help some people, there are some limitations to these medications. Patients might not be able to tolerate the side effects and they cannot be used in people with pre-existing heart or liver conditions.

History of botox for migraines

The first documented use of botulinum toxin was seen in 1820 when a description of the toxin was published. During the 1990s, the use of botulinum toxin for treating headaches began to garner more interest amongst the scientific community. It was of much interest as to how a potential poison could be used to benefit pain. This led to a paper being published in the Harvard Health Letter which was titled “feed a cold, starve a fever and poison a headache”. 

In the 2000s, patients receiving botox injections for cosmetic reasons began reporting improvements in their headaches. After several large and detailed clinical trials, botox was approved for the treatment of migraines in 2010. 

Botox: mechanism of action 

The bacteria, Clostridium botulinum, produces a toxin³ which causes paralysis of muscles. This toxin is responsible for causing a type of food poisoning called botulism, but it can also be purified and used in small quantities for various medical purposes. The most commonly known purpose is to treat wrinkles. It can also be used to treat muscle spasms and strabismus (crossed eyes). 

It has been discovered that botox injections can also help to reduce the frequency and severity of migraines. In the UK, botox injections have been approved for the treatment of chronic migraines. The NHS defines a migraine as being chronic if you have at least 15 days of migraines in a month and at least 8 of these days are accompanied by other neurological symptoms of migraines. 

Here are some guidelines set out by the National Institute of Health and Care Excellence (NICE) as to when a patient can receive botox injections to treat migraines:

• The patient must have already tried and failed three other preventative treatments 
• The patient must have been tested and treated for medication overuse headaches (headaches which occur due to excessive use of headache medication, also known as rebound headaches)

After these criteria have been met, a patient can then be offered botox injections for their migraines. 

Although the exact mechanism is still unknown, it is thought that botox can interrupt the pain pathway and disrupt pain-associated neurotransmission which can help to prevent migraines. 

Botox injections are administered by a trained healthcare professional. The injections will be quite small and will target the area under your skin or directly into the muscles which surround your forehead, ears and neck.⁴ In total, there might be around 31-39 injections given. The process is repeated every three months when the Botox starts to wear off. 

Efficacy and safety

As with any procedure, there are certain side effects and risks. Some of these might be:

• Some pain, swelling and bruising is to be expected at the injection sites, but this is usually short-lived
• A new or worsening migraine for a few days after the procedure 
• Headache or any flu-like symptoms 
• Slight drooping on one side of the face such as an eyelid or the corner of the mouth
• A watery or dry eye
• Some drooling 

These side effects are common but they are minor and they will eventually go away. However, there are some risks which can be potentially more harmful and they occur if the toxin accidentally spreads to your body. 

Seek medical help if you experience any of the following: 

• Muscle weakness
• An inability to control your bladder
• Problems with speaking or swallowing 
• Visual disturbances 
• Problems with breathing 

Some patients may not be eligible for botox injections are^4: 

• If you have a known allergy to Botox or if you have previously suffered from botulism
• An infection near the place where you will be injected
• Any scarring or keloids near the injection site 
• During pregnancy or breastfeeding
• If you have previous muscular weakness disorders (for example, ALS or myasthenia gravis) 

Treatment process

Before you are offered botox injections, your healthcare provider will assess you to see if you meet the criteria which is set out by NICE. If you do, you will be further assessed to make sure there are no contra-indications for you to receive the botox injections. After you have been approved, the injections will be administered by a trained healthcare professional every three months.

You might have to get two or three sessions of Botox before you start to feel relief in the frequency and severity of your migraines. After the session, you can arrange for someone to drive you home but this is not a requirement and you could even return to work if you feel well enough. 

There are some things you should avoid immediately after the procedure: 

• Hair washing; it is probably best to wash your hair before your appointment 
• Strenuous exercise 
• Cleaning the injection sites 
• Massages and saunas 

Long-term effects and sustainability 

Although botox injections are available to patients for free on the NHS, they are quite pricey for the NHS and can cost anywhere from £100 to £350. These injections are also available at private clinics across the UK but are slightly more expensive and can cost up to £550. 

The long-term outcomes of botox injections have also been assessed in various studies.⁶ It has been proven to be effective in controlling chronic migraines and it has also proved to be safe for long-term use. 

There is a slight risk for potential long-term side effects such as muscle weakness or a slight drooping around the eyes. However, these are rare side effects and the benefits of these treatments greatly outweigh the risks. 

Summary

Migraines can be very distressing. When other symptoms are involved, they can be debilitating and prevent a person from carrying out their normal daily activities. They are fairly common and there has been much research conducted into how to prevent and treat migraines. There are various new medications and treatments which are being explored every day. 

Botox has been used for migraines for many years and has proven to be safe and effective. Botox is derived from a bacteria. The toxin itself can be poisonous if consumed in contaminated food. Small quantities of purified toxin is used for various medical procedures.

The NHS offers botox injections for migraines to people who suffer from chronic migraines and who have already failed three other preventative treatments. The procedure does not take long but can be a little painful as multiple injections are made into the skin and muscles of the head and neck. Several sittings of this procedure are needed before you may notice any improvement in your migraines, this can be done every three months. 

It is a relatively safe procedure with minor side effects which are expected to disappear over time. It is important to have a trained healthcare professional administer these injections.

Though it is quite a costly procedure, it has shown excellent results in treating patients with migraine.