Using botulinum toxin A (Botox) injections for chronic migraine sufferers helps them “a little”, and does not appear to be the amazing therapy some people believe or claim it to be, researchers from the Medical College of Wisconsin, Milwaukee reported in JAMA (Journal of the American Medical Association). The authors added that Botox was not better than placebo in preventing chronic-tension-type headaches or episodic migraine.

Botox has been approved for the preventive treatment of chronic migraines by the US Food and Drug Administration (FDA).

The researchers wrote, as background information in their article:

“Migraine and tension-type headaches are common. Although up to 42 percent of adults experience tension-type headaches sometime in their life, most do not seek medical advice.

Migraines are less common, with a worldwide prevalence between 8 to 19%, but as associated with greater disability. Migraine headaches are responsible for $1 billion in medical costs and $16 billion in lost productivity per year in the United States alone.”

However, the majority of the reports either had unconvincing evidence regarding Botox’s migraine benefits, or contradictory findings.

Jeffrey L. Jackson, M.D., M.P.H. and team set out to determine whether Botox might be useful as a preventative therapy for chronic daily headaches, tension headaches, or migraine in adults. They examined and gathered data on 27 randomized placebo-controlled human studies involving 5,313 adults, as well as four other randomized comparisons using different drugs.

They explained that headaches can be classed as:

  • Episodic – when the sufferer gets up to 15 headaches monthly
  • Chronic – when the sufferer gets at least 15 headaches monthly (chronic daily headaches, tension headaches, or migraine attacks)

They found that those given Botox had moderately fewer monthly headaches – out of 1,115 patients, 2.06 fewer headaches monthly. Chronic migraine attacks among 1,508 patients who received Botox dropped moderately too, by 2.3 headaches per month.

Botox did not, however, reduce the frequency of chronic tension-type headaches among 675 patients, neither did it alter the rate at which 1,835 sufferers of episodic migraine had attacks.

The following possible undesirable side effects were linked to those receiving Botox, when compared to the placebo patients:

  • Drooping of the upper eyelid (blepharoptosis)
  • Neck pain
  • Stiffness in their necks
  • Tightness of the skin
  • Tingling, or a prickly sensation (paresthesias)
  • Weakness in muscles

Botox was found to be no better than topiramate in reducing headache frequency, or amitriptyline for migraine frequency.

The authors wrote:

“Botulinum toxin A was not associated with a reduction in headache frequency vs. valproate in a study of patients with chronic and episodic migraines (0.84 headaches per month) or in a study of patients with episodic migraines (0.3 headaches per month).

Botulinum toxin A was associated with a greater reduction in average headache severity than methylprednisolone in a single trial among patients experiencing chronic tension-type headaches (-2.5 headaches per month).”

The researchers concluded:

“Our analyses suggest that botulinum toxin A may be associated with improvement in the frequency of chronic migraine and chronic daily headaches, but not with improvement in the frequency of episodic migraine, chronic tension-type headaches, or episodic tension-type headaches.

However, the association of botulinum toxin A with clinical benefit was small. Botulinum toxin A was associated with a reduction in the number of headaches per month from 19.5 to 17.2 for chronic migraine and from 17.5 to 15.4 for chronic daily headaches.”

Written by Christian Nordqvist