Botulinum toxin is probably best known by one of its brand names, Botox, and for its ability to temporarily smooth facial wrinkles. Now it’s being recommended by the American Academy of Neurology (AAN) as a treatment for chronic migraine too. The AAN in April updated its guidelines on the uses of botulinum toxin based on the latest scientific evidence.
The U.S. Food and Drug Administration had approved onabotulinumtoxinA (Botox) in 2010 for use in adults who experience migraines on 15 days or more a month. Botox can help dull headache symptoms and reduce migraine episodes by blocking nerve endings.
According to the American Headache Society, Botox to prevent chronic migraine requires 31 injections using a tiny, sharp needle in the areas of the forehead, bridge of the nose, temples, upper back, neck, and back of the head.
Botox is injected every 12 weeks for a total of five treatments over 15 months and is best given by a skilled clinician who has experience with the injections. They may feel like pinpricks and are not especially painful, but the Botox mixture itself might cause a brief burning sensation at the injection site. The injections are performed in the doctor’s office and should take about 15 minutes. Side effects may include neck pain and stiffness and muscle weakness.
It may take two treatments before improvements are seen. If there’s no reduction in headaches after 24 weeks, it’s unlikely that the treatment will have any effect if continued. Injections may be costly—as much as $3,000 per treatment—so if you’re considering Botox, check with your health insurer for coverage information before beginning therapy. Medicare and Medicaid cover Botox treatments for chronic migraines.
The studies on which the AAN based its recommendation show a small improvement in headache frequency, but they didn’t compare Botox with other migraine drugs such as propranolol, amitriptyline, and topiramate, which may be as effective.
In addition to recommending botulinum toxin for migraines, the AAN recommended various forms of the toxin to help control blepharospasm, a movement disorder that causes uncontrolled blinking or eyelid closing; adult spasticity, often resulting from a stroke, multiple sclerosis, or a spinal cord injury; and cervical dystonia, a disorder that causes involuntary and sometimes painful head and neck movement or spasms. The guidelines were published in the May 2016 edition of Neurology.