What is a migraine? Why migraine happens. Who gets migraines? Treating migraines.

Botox, Cosmetic Surgery and Migraines

In July 2010 Botox (onabotulinum toxin A) was licensed as a method to treat chronic (daily) migraines. It's licensed for use in 39 sites in the head and neck muscles. Researchers first became aware of the potential for Botox to help headaches after patients in the mid-1990s reported an improvement in the intensity and frequency of their headaches after receiving botulinum toxin for cosmetic reasons.

What is Botox?

Botox is a brand name of a highly diluted botulinum toxin. This toxin causes botulism, a paralysis of the muscles. It was first described in 1817 but the bacterium responsible for the toxin (Clostridium botulinum) wasn't discovered until 1895. In the 1970s and 1980s the toxin was introduced clinically as Botox. Its use wasn't originally for cosmetic reasons. Botox was used medically to treat blepharospasm (twitching of the eyelid) and squinting problems. It was also used to treat post-stroke spasticity, dystonia (writer's cramp) and excessive sweating (hyperhidrosis).

How It Works

Researchers aren't entirely sure how botulinum toxin works to relieve chronic migraine pain. There's even disagreement among the medical community as to whether it really works. Those who believe it works guess that the toxin inhibits the release of peripheral nociceptive neurotransmitters which affects the central pain processing systems. Migraines are more than overactive muscles so the fact that Botox relaxes muscles has no impact on the severity and frequency of the headaches.

Not a Choice for Everyone

Botox injections as a method of migraine treatment are expensive. For the toxin to work, it needs to be given in specific locations every twelve weeks. Some studies show that the toxin can create worse headache symptoms in about one out of every 10 people. Some get a rash, itchy skin, muscle spasms or overall stiffness as a reaction to botulinum toxin. Occasionally Botox can cause anaphylactic shock.

Conflicting Views

In February 2011 the Drug and Therapeutics Bulletin (DTB) said that Botox does not offer much benefit as a treatment for chronic migraines. The UK's drugs regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA) disagrees insisting that Botox offers a "unique approach to the treatment of chronic migraine." The DTB insists that the trials proving the effectiveness of Botox as a treatment for chronic migraines were inaccurate since two thirds of the participants overused headache treatments. Overuse of headache treatments can cause headaches which means that those who thought they suffered from chronic migraines likely didn't, according to the DTB.