Botox has an outstanding reputation for reducing the appearance of frown lines and wrinkles and is used worldwide by women and men to achieve a healthier, more youthful appearance. It also has a wide range of medical applications. But are there risks involved? Is it safe? We asked Dr Tim Beazleigh MBChB, BMSc, MLCOM, our lead medical practitioner, for his view on the use of Botox.
Botox (botulinum toxin A) was licensed as a preventative treatment for chronic migraines in 2010 by the Medicines and Healthcare Products Regulatory Agency (MHRA). Although it has been proven to be highly effective when used to treat chronic migraines, it’s use as a treatment for other types of headaches such as episodic migraines, tension-type headaches and cluster headaches requires further research. This article outlines the benefits of using Botox to help reduce the pain and discomfort of chronic migraines.
What is Botulinum Toxin?
Botulism – a rare paralytic illness caused by a toxin produced by the bacteria Clostridium botulinum – was first discovered in 1817 by the German physician and poet Justinus Kerner. Clostridium botulinum was not identified as the cause of botulism until 1895, when a botulism outbreak in the small Belgian village of Ellezelles enabled Emile Pierre van Ermengem, Professor of Bacteriology at the University of Ghent, to identify Clostridium botulinum as the pathogen responsible for the disease.
Botulinum Toxin Type A as a Medicinal Treatment
A highly diluted preparation of botulinum toxin type A was introduced as a medicinal treatment in the 1970s and 1980s for patients with strabismus (lazy eye) and blepharospasm (inability to move the eyelids in a certain way). Since then it has been used to treat a variety of other ailments such as dystonia (including writer’s cramp), post-stroke spasticity and hyperhidrosis. Other variations of botulinum toxin type A (Dysport and Xeomin) and type B (Neurobloc or Myobloc) are available, but their effectiveness for pain management and treating headache disorders has not been scientifically tested to any great degree.
Botulinum Toxin and Chronic Migraines
In the mid-1990s a number of respected medical professionals who were treating patients suffering from chronic headaches reported a significant reduction in the pain caused by migraines in those patients that were receiving Botox injections for other reasons. Scientific and clinical trials of the use of botulinum toxin to treat various different types of headache soon followed, but the results were inconclusive and often disappointing, with no difference over placebo being found in tension-type headache, episodic migraine and undifferentiated chronic headaches. In-depth analysis of the results suggested, however, that there might be a subgroup of patients with chronic migraines who could benefit from such injections, and further medical trials were conducted.
Botox, Chronic Migraines and the PREEMPT Trials
Two Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials recruited 1384 patients who were suffering from chronic migraines, and these patients were randomly administered either a Botox or placebo treatment. On average, each of these patients were suffering headaches 20 times per month, of which 18 occurrences were classed as moderate or severe. Those patients who had been administered Botox received fixed-site, fixed dose injections every 12 weeks over a period of 56 weeks. Between 155-195 units of botulinum toxin type A was injected into seven specific areas of the head and neck, and after six months and two cycles of treatment, those treated with Botox experienced on average eight days less of severe headaches each month. After 12 months of injections, 70% of those patients treated with Botox injections saw a 50% reduction in the number of headaches they suffered each month. The injections themselves caused very few side effects, the most common side effects being neck pain (6.7%), muscular weakness (5.5%) and drooping of the eyelid (3.3%). No serious, irreversible side effects have ever been reported in any trials related to using Botox injections to treat headaches.
How Does Botulinum Toxin Work to Prevent Chronic Migraines?
Botox can help to prevent severe headaches by temporarily paralysing key muscles in the forehead, neck and shoulders, blocking the nerve connections and alleviating the pain and discomfort caused by chronic migraines. Botulinum toxin has been scientifically proven to reduce pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain, and bladder pain. Botulinum toxin is also thought by many medical practitioners to inhibit the release of peripheral nociceptive neurotransmitters, which may then have a knock-on effect on the central pain processing systems that generate migraine headaches.
Are Botox Injections Right for Me?
Before any Botox injections are administered, a medical consultant will discuss your treatment options with you in order to decide the the most appropriate and effective course of action and to determine whether using Botox to treat your headaches is clinically appropriate for you. Our medical consultant will discuss with you your medical history relating to chronic migraines, including symptoms, frequency of attacks and any medication taken. Patients suffering from chronic migraines (headaches occurring on 15 or more days each month) generally see the best results in terms of pain reduction and fewer headaches. In addition to Botox injections, we also offer holistic treatments such as osteopathy and acupuncture in order to maximise the effectiveness of the treatment sessions.
Who can Inject Botox for Chronic Migraines?
Before any Botox treatment is carried out, you should always ensure that the person administering you with Botox injections has received the appropriate training, both in the diagnosis and management of chronic migraines, and in the delivery of Botox according to the proven PREEMPT schedule. At Melior Clinics we pride ourselves on the standard of medical expertise and knowledge that we offer our clients, and all of our staff are highly trained in the use of non-surgical cosmetic procedures. If you would like to find out more about how our Botox London clinic can help to reduce the pain and discomfort caused by chronic migraines, book a free consultation to speak to one of our consultants.