Botox

29 May 2019

Botox Side Effects: Long Term

A new study casts some light on Botox (onabotulinumtoxinA) treatment and how side effects change over time. If you’re using Botox to treat chronic migraine, or if you’re considering it, take the time to look at this study.

This study comes out of the USA and was published this month in Drug Safety: The Official Journal of the International Society of Pharmacovigilance. It compiles about two years of information from what was called the COMPEL study – The Chronic migraine OnabotulinuMtoxinA Prolonged Efficacy open-Label Study. Although “long term” was only about 2 years, the study does provide valuable insights into the side effects of Botox.

Before we get to the specific side effects, it’s worth noting that the study does confirm the general safety of Botox treatment. Although many patients withdrew from the study for various reasons (such as simply not staying in contact or not following the study protocols), only 3.5% withdrew specifically because of “adverse events” or side effects.

Only a small percentage of those were “serious adverse events”, and the researchers believe that only 1 patient (716 started the study) had a serious adverse event actually related to the Botox treatment – and that was a rash. Of course, there are always patients who respond poorly to medication (or even to food!), so this is a pretty good record.

But Botox is not completely free and clear, because there were reported side effects. First, let’s look at the common ones. Then stay tuned for a very important clarification.

Here are the most common side effects. None of these were common – in other words, you’d be unlikely to find even one patient in 10 with the most common side effect.

Neck pain
Eyelid ptosis (droopy eyelid)
General stiffness or weakness
Pain at injection site
Headache and/or migraine symptoms
Facial paresis (muscle weakness)
Skin tightness

Now if you’ve experienced any of these side effects, there may be some good news for you. The side effects did tend to lessen with repeated treatments.

In this study, treatments were given every 12 weeks. The neck pain was the worst after the first cycle – it decreased significantly after that. Headache and migraine symptoms were the worst during the first two cycles (migraine symptoms actually increased during the second cycle), and then significantly decreased. Droopy eyelid decreased significantly in the second cycle, and then almost disappeared.

Generally speaking, side effects decreased after the third cycle. By the fourth treatment, side effects were drastically decreased.

Now if treatment isn’t helping at all, you’re not likely to stick with it for four treatments. Remember, at every 12 weeks, that’s about 11 months. However, if you find that Botox is helping after you’ve tried it two or three times, you might be encouraged to know that the side effects should be far less at treatment 4 (or even 3) and beyond.

Also remember, there are ways to be safer with Botox treatment. See How to be Safe with Botox (10 tips).

It will be interesting to see even longer term studies in the future. But at this point, this study confirms what other studies have shown us. Side effects are minimal, and tend to be even fewer as the months pass.

To read the abstract, or the whole study, visit Long-Term Safety and Tolerability of OnabotulinumtoxinA Treatment in Patients with Chronic Migraine: Results of the COMPEL Study.

26 November 2018

Could non-invasive Laser Therapy replace Botox for Migraine?

James News, Treatments 0

We’ve talked before about an up-and-coming migraine treatment known as LLLT, or low level laser therapy. This is a non-invasive therapy that uses low level lasers to stimulate cells. It’s a treatment used for other pain conditions as well – read more here: Laser Therapy (LLLT) for Migraine

green lasers! Researchers in Brazil wanted to investigate how LLLT compares to the more well known Botox (onabotulinumtoxinA) treatment for chronic migraine. Why? Because LLLT could end up being a lot cheaper, for one thing. Also, it’s less invasive than Botox treatment.

The study, published last month, found that LLLT treatment was indeed comparable to Botox. Both did help patients with chronic migraine. One small difference was that patients treated with Botox seems to have a little lower anxiety (as a migraine symptom) after treatment, and those with LLLT seemed to have more improvement in sleep patterns. On the downside, sometimes pain increased initially with Botox treatment, and a few patients complained of a temporary “burning sensation” with the LLLT treatment.

The researchers were quick to point out that this was a small, preliminary study. The study was open label – patients knew what they were getting. They also noted that there was more “human interaction” with the LLLT treatment, something that could improve outcomes.

Due to the newness of LLLT, there is reason to believe outcomes could improve as we learn how to use it. The same is true of Botox, even though it has become more common as a migraine treatment.

Another comparison was the LLLT treatment takes more time. But the monetary savings were still significant.

This is not to say that LLLT would necessarily replace Botox treatment. Botox still may work better for some. But if a cheaper treatment, with less danger of side effects, could be tried first, it may benefit many patients.

More on this study: Botulinum toxin A (BT-A) versus low-level laser therapy (LLLT) in chronic migraine treatment: a comparison

18 July 2018

An Ambitious Study to make Botox Affordable

James News 0

In spite of its popularity, Botox treatment for migraine still has a long way to go. We need not only better evidence, we need to know how to better use it, and who will benefit most. And, of course, it would be great if the cost were lower!

A study in Norway and the USA is setting ambitious goals to answer some of these questions.

Skull sutures You may remember last fall when we talked about how researchers were trying to find ways to predict who Botox would work for. Also, about a year ago, researchers were trying a new approach with a lower dosage of Botox.

That method was a “follow the pain” approach. The new study is a “follow the sutures” approach. Sutures are the places where the bones of your skull join together.

We won’t hear the results of the study for some time, but the goals tell us something about what researchers want to do with this treatment . . .

Gather better evidence
Find a more effective procedure
Use half of the injection sites
Lower the cost by half
Minimize side effects

Other than the new injection sites, researchers are diluting the dosage, which should allow the medicine to spread well to where it’s needed even though it’s a lower dose.

We should be encouraged that researchers are looking for ways to make treatments that are helping people better and cheaper.

To read about the trial, see “Follow the Sutures”. A New Procedure for Injection of Botulinum Toxin for Chronic Migraine.

15 February 2018

Sleep, Bruxism, Headache and … Botox?

James Discoveries & Stats, Treatments 0

Often, seeing connections between two conditions can help us find better treatments for a particular patient. And a recent study on Botox and bruxism may lead to better treatments for migraine.
Bruxism and Migraine
Bruxism refers to the clenching or grinding of your teeth at night. You can do it, and not even know it. But it could be a trigger for migraine attacks, or tension type headache.

There are some effective treatments that can help with bruxism – and are likely to help with headaches too – such as the NTI-tss device.

But a recent study suggests that onabotulinumtoxinA, well known under the brand name Botox, may help with bruxism as well. (Abstract: Onabotulinum toxin-A injections for sleep bruxism)

In the (small) study, some patients were given a placebo, and others Botox injections. Those who received the injections were more likely to improve over the next few weeks.

Although only a small introductory study, these results may tell us a couple of things. First, if you have migraine and bruxism, it may be more likely that Botox will work for you.

Also, doctors who know that their patients are dealing with migraine and/or tension-type headache may find that they can treat both with Botox. Will this also inform which injection sites are used in various patients – that is, what type of Botox treatment they get? It could very well be.

Have you found Botox helping you with bruxism, or at least helping you get a better sleep? Leave a comment!

For more on the study, see

27 November 2017

Researchers Looking for Predictors of Botox Success in Migraine

James Uncategorized 1

Excuse the complicated title to this article, but this is what it means in plain language. Botox, or onabotulinumtoxinA, has been very helpful for patients with chronic migraine. But it certainly helps some people more than others. Researchers want to know why, and they also want to know if there is an easy way to predict which patients will respond best to Botox.

Blood Tests and Botox Today, patients need to go through all the treatments before they know if they will work. But what if you could go for a simple blood test which would tell you ahead of time that your treatment had a – say – 87% chance of success? Or maybe a 16% chance of success? That would save everyone a lot of time and money.

A study published earlier this month in the journal Headache found that certain markers may predict Botox success.

First, CGRP levels. We’ve heard a lot about CGRP (calcitonin gene-related peptide) lately, because of the new migraine medications that are coming out. CGRP levels an important part of the trigeminovascular system, and seem to play a role in communicating pain messages in the body. Levels were higher in patients who responded well to Botox treatment. (This is not the first time this has been observed – see Botox and CGRP – and the Future of Migraine Treatment

Second, PTX3 levels. High PTX3 (pentraxin 3) levels have been linked to inflammatory and vascular issues. Patients with higher PTX3 levels were also more likely to respond to onabotulinumtoxinA treatment.

Though this is likely one of many studies that need to be done, this kind of information will not only help us predict who is most likely to benefit from Botox treatment, but should also help us understand both disease and treatment better, so that we can make better options available in the future.

Read the study abstract here: CGRP and PTX3 as Predictors of Efficacy of Onabotulinumtoxin Type A in Chronic Migraine