Botox jab ‘unlikely to ease migraine’

9th February 2011 - The popular anti-wrinkle jab, Botox, is unlikely to offer much benefit to the one in seven people in the UK affected by migraine, according to an article in a drug and treatment review journal.

Migraine pain and symptoms affect 18% of women and 8% of men and is the most common form of disabling headache that sends patients to see their GP.

Although Botox is best known for its ability to smooth wrinkles, it is also licensed for use to relieve the symptoms of chronic migraine as a series of regular injections into between 31 and 39 sites in the head and neck muscles. How it is supposed to work is not entirely clear, but this action appears distinct from Botox’s well-known paralysing effect on muscles that has made it popular among ageing celebrities.

Each treatment with Botox for chronic migraine costs around £276 and the injections have to be given every 12 weeks.

‘Limited and unconvincing’

A review in the latest edition of the BMJ’s Drug & Therapeutics Bulletin (DTB) examined the evidence on how effective Botox is as a treatment for chronic migraine and found it “limited and unconvincing”. The review also found that Botox led to a worsening of headache symptoms in around one in 10 people, with a similar proportion developing itching, rash, pain, stiffness and muscles spasms.

Furthermore, it said Botox can prompt anaphylactic shock and, despite screening controls, the possibility of transmitting an infection with Botox cannot be ruled out entirely, because the drug contains human serum albumin.

The DTB article notes that when the UK’s drugs regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), approved the use of Botox for migraine patients, it said it offered a “unique approach” to the treatment of chronic migraine and had a “more favourable safety profile” than treating with tablets.

DTB points out that some headache specialists have criticised the standard of evidence which prompted the MHRA to make its licensing decision. The article concludes that it is “difficult for us to see a place for botulinum toxin A as treatment for chronic migraine”.

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Dr Fayyaz Ahmed, trustee of The Migraine Trust, said in a statement: “Botox remains a treatment option in patients with chronic migraine particularly for those who may have exhausted other available treatment options.  There are some patients that have responded well to treatment with botulinum toxin type A, while others did not.”

Ahmed continued: “Neurologists and headache specialists who have had some experience in treating chronic migraine patients with Botox use their experience to make a decision as to which patients will benefit most from this treatment. If you suffer from headache for more than 15 days a month, of which more than half have migrainous features, you should be assessed by a headache physician who would inform you and appraise the available preventative treatment options."