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Botox for migraine

16 February 2012

Questions about Botox in the UK

In July 2010, Botox was approved as a preventive treatment for chronic migraine in the UK by the Medicines and Healthcare Products Regulatory Agency. But is there enough evidence for Botox? Should it be offered (funded) by the NHS (National Health Service) across England and Wales?

Medicine watchdog NICE (The National Institute for Health and Clinical Excellence) is saying "not yet". They feel that more data is needed, and they’re asking the makers of Botox (Allergan) to provide it.

Although the people with NICE admit that Botox seems to have some benefits in recent studies, they claim that the benefits have been small – small enough that they could be explained simply by the way the studies were conducted.

Proffesor Carole Longson, director of the health technology evaluation centre at NICE said,"Without this additional evidence, potentially we will be unable to advise the NHS that this drug is good value for money for these adults because there are currently too many uncertainties."

But NICE remains open to comments on their recommendation before they make it official. The deadline will be the 8th of March, after which NICE will put together it’s final guidelines.

The Migraine Trust and The British Association for the Study of Headache prepared a joint statement in response to NICE. As a part of their statement they said:

We know that BOTOX® is effective for some but not all patients who suffer from chronic migraine. We also know that many other preventative treatments are not effective for treating chronic migraine and that they can cause unacceptable side-effects. It would be extremely unfortunate if this treatment is denied to those who have exhausted all other options and those who have responded well to the treatment. The Migraine Trust advocates that this treatment should be made available to those who fail to respond to at least three preventative treatments to have a fair chance to see if BOTOX® treatment will work for them.

Read the full statement here.

15 February 2012

Botox for Migraine – how does it actually work?

James Information, Treatments 31

Botox, or onabotulinumtoxinA, is an emerging and at times controversial treatment for migraine. Many patients have found relief through Botox treatment, although others have found that it wasn’t very helpful for them. Par for the course when it comes to migraine treatment.

But just why does Botox help – at least some patients?

The most obvious answer seems to be the way it relaxes muscles. Certainly if tense muscles were triggering migraine attacks, or if they were a part of the chain-reaction or vicious-cycle of migraine, we would expect to see some relief if those muscles were relaxed.

And that still could be part of the answer.

But the pain of migraine (in fact, even the pain of tension-type headaches), does not come from muscle tension. Sure, it could be a part of the cycle, but is that really enough to explain the relief that many get from Botox?

Dr. Alexander Mauskop from the New York Headache Clinic writes about his observations:

I have seen some patients who would report that injecting muscles around the head eliminated pain in the injected areas, but that they still had pain on the top of the head. There are no muscles on the top of the head and we usually do not inject Botox there, but in those patients who do have residual pain on the top, injecting Botox stops the pain. Recent research has shown that Botox in fact also exerts a direct analgesic (pain-relieving) effect. This is supported by my and other doctors’ observation that Botox also helps other types of pain, such as that of shingles or trigeminal neuralgia.

He goes on to point out that we need some solid studies to confirm what many doctors and patients are seeing.

He finishes by saying that Botox seems to help by reducing the pain messages that are being sent to the brain. Without the flurry of pain messages to the brain, the migraine chain reaction can’t begin. In fact, some patients report that, after Botox treatment, they sometimes feel like a migraine is about to start, but it never does.

If you’ve had Botox treatment, how does this compare with your experience? Leave a comment!