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Treatment with Botulinum Toxin (Botox) for Migraines and Headaches

Botulinum toxin (Botox) has been recognized for its effectiveness in treating migraines. Botulinum toxin is used in the treatment of chronic migraine.

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Medicinsk godkendt artikel

Botulinum toxin (Botulinum Toxin A), also known as Botox, has been recognized for its effectiveness in treating migraines. Botulinum toxin is used in the treatment of chronic migraine, in which one has at least 15 days of headache, of which at least 8 of the days are with migraine. Botulinum toxin is not recommended for episodic migraine or chronic tension headache, as research studies have not proven an effect.

What is Botulinum Toxin?

Botulinum toxin is a nerve poison that is formed by a bacterium. The substance blocks the connection between nerve and muscle. It is used as a medical treatment for migraines and against increased activity of muscles, among others, in patients suffering from painful cramping conditions, but you may know it best used cosmetically as an anti-wrinkle remedy.

How does Botulinum Toxin work?

It is believed that when Botulinum toxin is injected, it blocks pain signals, thereby indirectly blocking the development of a migraine attack. However, the exact mechanism has not been established scientifically.

Treatment procedure of Botulinum toxin

Botulinum toxin treatment is done by injecting very small amounts of botulinum toxin into 31 different places in the muscles around your head, neck and shoulders. If the pain is worse in a certain area of your head, you may be given a little more injections in the area (s) where you have the most pain. It is the treatment procedure known as the Preempt protocol and is the treatment method that has been shown to be effective in studies of more than 1000 migraine patients. We recommend that you check with your healthcare professional to see if they follow this protocol.

The treatment itself should be carried out by qualified health professionals and takes about 10 minutes. If there is a good effect, the treatment can be repeated every 3-4 months.

Side Effects of Botulinum Toxin

After treatment, there may be slight discomfort and swelling at the injection sites (2), but this usually disappears within a few hours.

It is recommended to refrain from rubbing the treated areas for the first 24 hours.. Side effects can include fever and flu-like symptoms, a drooping eyelid, local muscle weakness, muscle aches, neck pain and rash, but are fortunately rare.

In very rare cases, serious side effects such as muscle weakness, difficulty swallowing and pneumonia can occur due to the spread of toxin. If you experience such symptoms, you should immediately seek medical help.

Who can not get the treatment

You should not receive treatment if:

  • You have previously reacted negatively to treatment with botulinum toxin type A.
  • You have an inflammation in one or more of the areas where you need to have injections.
  • You are pregnant or breastfeeding.
  • You suffer from chronic diseases that cause muscle weakening.
  • You have a fever

Sources:

  1. Danish Headache Society, Reference Programme 2020 (2020), https://dhos.dk/wp-content/uploads/2020/06/2932-Referenceprogram_2020_final_web-24.06.20.pdf 
  2. National Knowledge Center for Headache - Treatment with Botulinum Toxin https://videnomhovedpine.dk/sites/default/files/paragraph/field_download/NVH_Behandlingsark_botox.pdf
  3. Sundhed.dk, Visitation criteria - referral of headache patients (26.01.2021), https://www.sundhed.dk/sundhedsfaglig/information-til-praksis/syddanmark/almen-praksis/patientbehandling/patientforloeb/visitation/ouh/visitationskriterier-henvisning-af-hovedpinepatienter/

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