BOTOX® Effective treatment for chronic migraines
BOTOX® is a licensed product for the treatment of chronic migraines.
Cheryl Creaghan (Specialist Headache Clinician) is one of only five clinical specialist educators in the UK
With 25 years’ clinical experience in neurology. Cheryl has spent the last 16 years dedicated to enhancing the care of patients suffering chronic migraines. Cheryl is one of only five clinical educators in the UK with a licence to train other practitioners in the administration of BOTOX®.
Why not have the best treatment administered by one of country’s leading practitioners?
Dependant on your specific condition and your diagnosis we offer a variety of treatments tailored to you as an individual. These include:
- Lifestyle management
- Medication review
- BOTOX® for the specific treatment of chronic migraine.
Frequently Asked Questions re:BOTOX®
- What is BOTOX®?
BOTOX® is a purified protein that is made from a type of bacteria called Clostridium botulinum.The toxin comes from a germ (a bacterium) called Clostridium botulinum. The way it is taken from the germ and prepared for clinical use varies between the different manufacturers, so different brands of botulinum toxin may work differently, and should not be interchangeable. BOTOX® is a brand of botulinum toxin. There are other brands, but these have not been proved helpful in any form of migraine or headache.
- What is BOTOX® used for?
In 2010, the FDA, approved intramuscular botulinum toxin injections for prophylactic treatment of chronic migraine headache, it was approved for use in the NHS by the National Institute of Clinical Excellence(NICE) in 2012.BOTOX® is licensed for the treatment of chronic migraine, defined as 3 months of at least 15 days of headache a month, of which at least 8 days have migrainous features, such as nausea, light or noise sensitivity, pulsating or lateralised pain.
- How is it given?
BOTOX ® is given as a series of 31 to 39 tiny (0.1 ml) injections into the muscles in and around the head, neck and shoulders. The injections are repeated every 12-14 weeks until the patient no longer has chronic migraine, or until it is clear that treatment is not working. Normally a response is seen after the first or second set of injections; only about one in ten people respond to a third set of injections if the first two sets fail.
- How effective is it?
The realistic goal is to improve quality of life, and to convert migraine from chronic to episodic.About three in four patients respond; one in four respond well to the first or second set of injections, and half need more than two sets of injections to get a good response. Studies show show that 47% of patients had a 50% or greater reduction in the number of days with headache.
The biological effect of botulinum toxin on nerves takes several days or a few weeks to work. You should not expect chronic migraine to improve properly in less than 4 weeks. Some patients do not start to improve until after their second set of injections which is given 12-14 weeks after the first set of injections.
Two Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials recruited 1384 patients with chronic migraine, and randomised them to treatment with BOTOX® or placebo. These patients were suffering on average 20 days of headache each month, of which 18 were moderate or severe. Those randomised to BOTOX® received fixed-site, fixed dose injections every 12 weeks over 56 weeks. These injections covered seven specific areas of the head and neck, with a total dose of between 155-195 units. At six months, after two cycles of treatment, those treated with Botox® had on average eight less days of headache each month. After 12 months, 70% of those treated had ≤50% the number of headaches that they had done originally.
- How does BOTOX® work?
The simple answer is that we don’t know – yet.It is thought that botulinum toxin gets into the small nerves that carry pain from the head to the brain, known as C-fibres. This reduces the amount of chemicals released from the nerve ending and therefore interrupts the feedback pathway that perpetuates migraine and headache.
- What side effects might I get?
The injections are slightly prickly or stingy and take about 15 minutes to complete.It is possible, though rare, to have an acute allergic response so you should stay in the clinic for several minutes after the first set of injections.
Less than one in ten patients experience:
- Worsening migraine. This can begin within a day or two of the injections, usually lasts a small number of days. It can be treated with triptans and/or regular naproxen 250 mg or 375 mg three times daily after meals.
- Rash, itching
- As with all injections; pain, bruising, bleeding or infection where the injection was given are a possibility
- Drooping of eyebrows or eye lids. This begins after a couple or a few weeks and can last for a small number of weeks.
- Muscle weakness, pain, cramp, stiffness or tightness
- Weakness and pain in the neck. This begins after a couple or a few weeks and can last for a small number of weeks. It can be treated with regular naproxen as in (1) above.
Less than 1 in 100 may experience:
- Difficulty in swallowing
- Skin pain
- Jaw pain
- Swollen eyelid
If you have any difficulty in breathing, speaking or significant swallowing problems after receiving BOTOX® seek immediate medical advice.
If you experience hives, swelling including the face or throat, wheezing, feeling faint and shortness of breath seek immediate medical advice.
- Who can’t have BOTOX® for migraine?
BOTOX® is only for chronic migraine: not any other sort of migraine.People who are pregnant or breastfeeding may not have BOTOX®.
If you have other neurological disease, for example Bell’s palsy, a neuropathy, or Myasthenia Gravis, the risks of BOTOX® are increased.
If you have recently (within the last 3 months) had cosmetic botulinum toxin, then the side effects could be increased.
Have inflammation, weakness or wasting of the muscles/skin where your doctor plans to inject
Have had problems with swallowing or food or liquid accidentally going into your lungs, especially if you will be treated for persistent muscle spasms in the neck and shoulders
Suffer from any other muscle problems or chronic diseases affecting your muscles
Suffer from certain diseases affecting your nervous system
Have an eye disease called closed-angle glaucoma or were told you were at risk of developing this type of glaucoma
Tell your specialist if you:
Have had problems with injections (e.g. fainting) in the past
Have had problems with previous botulinum toxin injections
Have had any surgery that may have changed the muscles that are being injected
Will have an operation soon
Are taking any blood thinning medicine