The idea of putting botulinum toxin type A (Botox) injections to work for migraine relief cropped up when people with chronic headaches got Botox for cosmetic purposes (such as ironing out wrinkled foreheads) and experienced, in addition to vanished facial lines, headache abatement.
This observation spurred batches of case series studies (involving case reports on patients given similar treatment but no control groups) that suggested a benefit. In 2010, the Food and Drug Administration approved Botox injections for preventive treatment of chronic migraine (headaches more than 15 days per month). Still, the medical literature on the effectiveness of Botox for headaches has been mixed overall.
In April 2012, the Journal of the American Medical Association (JAMA) published a review of past studies that concluded Botox injections provided a small to modest benefit for people with chronic migraine or chronic daily headaches but was no better than a placebo in preventing episodic migraine (headaches fewer than 15 days per month) or chronic tension headaches.
Medical College of Wisconsin researchers who completed the meta-analysis (or, examination of several past studies) of 27 randomized placebo-controlled trials involving 5,313 adults found Botox to be associated with about two fewer headaches per month in those with chronic migraines or chronic daily headaches but no fewer headaches in those with episodic migraine or chronic tension headaches.
“While most patients experience only small to moderate improvements, some people with migraine can experience very positive results,” said lead study author Jeffrey Jackson, MD, a neurology professor at Medical College of Wisconsin, “and some can experience no benefit.”
There’s no way of knowing in advance how an individual will respond because, explains Jackson, no studies have analyzed possible indicators of treatment success.
The researchers also analyzed four studies that compared Botox injections with medications commonly prescribed to treat migraine and concluded that Botox did not outperform amitriptyline (Vanatrip, Elavil, Endep), topiramate (Topamax), or valproate (Depacon). One trial involving adults with tension headaches did find that Botox more greatly reduced headache severity than methylprednisolone (Medrol).
Overall, Botox may be linked to fewer chronic migraines and chronic daily headaches. On average, when benefits occur, they tend to be moderate at best. If you’ve tried other migraine treatments (for example, taken at least two different prescription drugs from two separate medication classes) without success, consult your doctor about Botox. Treatment success is typically defined as reduction of migraine severity and/or frequency of at least 50 percent.
Have You, or has anyone You know, tried Botox injections to treat migraines?