Botox has been known for many years as a chemical that can make you look ‘younger’ by decreasing the appearance of fine lines and wrinkles. It has been a staple name in the cosmetic industry. However, more recently, it has made the news as a treatment for chronic migraines. Clinical Pharmacist and The W’s Health and Wellness Editor breaks this concept down for us.
The National Institute for Health and Care Excellence (NICE) published final guidance in June 2021, recommending Botox injections to prevent headaches in some adults who experience chronic migraine. Since then, Botox has been approved for use on the NHS for the treatment of chronic migraine in adults. In this case, chronic migraine is defined as having at least 15 headache days a month, 8 of which are migraines.
Migraines are a very common health condition, women are more susceptible to migraines as it affects 1 in 5 women, compared to affecting 1 in 15 men. Migraines can affect any age but they usually start in the late teens or early 20s. Many people also have symptoms such as feeling sick, being sick and increased sensitivity to light or sound. Women can also experience migraines before, during and even some days after their period. Stress, anxiety, depression, excitement, tiredness and certain foods (such as coffee and chocolate) have also been known to trigger migraines. The exact cause of migraines is unknown, however, it has been thought to be down to temporary changes in the chemicals, nerves and blood vessels in the brain.
What is Botox?
Botox (botulinum toxin type A) is a type of nerve toxin that paralyses muscles. Hence why people who receive Botox injections have a seemingly stiff face that does not wrinkle. Botox comes from a bacterium known as Clostridium botulinum. It was discovered as effective for people with chronic migraine while being used for cosmetics treatment. It was found that people who had Botox experienced fewer headaches. During a migraine, your body releases substances called neurotransmitters and molecules that are associated with pain. Botox interferes with this pain-associated neurotransmission. It's not exactly clear why this treatment can be effective for migraine.
Who is eligible for Botox migraine treatment?
Current treatment for migraines includes paracetamol, ibuprofen, triptans and anti-emetics - for sickness. During an attack, many people find that sleeping or lying in a darkened room can also help. However, some people suffer from migraines severely to the point that treatment is ineffective. This is where preventative treatments, such as Botox come in.
As mentioned above, Botox migraine treatment is limited to those who suffer from headaches for at least 15 days of the month and suffer from a migraine for at least 8 of those days. Before being able to be treated with Botox, the patient would have had to try at least 3 other pharmacological prophylaxis therapies, in other words - drugs that prevent migraine, such as Topiramate, Propranolol or Amitriptyline.
How is Botox given?
Under the NICE guidelines, Botox should be given by injection to between 31 and 39 sites around the head and back of the neck and a new course of treatment can be given every 12 weeks. The injections are small and will be carried out by a trained professional. The effect of Botox will be monitored to see if the quantity and severity of migraines decrease. Also, if there is no improvement in the migraines, then the Botox treatment may be stopped.
Allergan estimates that the administration cost is £73 per treatment, based on a total treatment time of fewer than 30 minutes; therefore, the total cost for treatment and administration of treatment per 12-week cycle, assuming no vial sharing, is expected to be around £350.
It is important to note that this cost may vary depending on the individual patient and their specific needs, as well as any additional costs for monitoring and follow-up appointments. Additionally, the cost may be different in different countries or regions.
Are there any side effects?
I don’t think any medication exists without potential side effects. However, Botox is usually well-tolerated, hence why people have been using it for so many years. The most common side effects include neck pain, muscular weakness and drooping of the eyelid. These side effects are temporary because the treatment wears off over time.
In conclusion, Botox is only available on the NHS for chronic cases. My advice will be to speak to your healthcare professional before deciding on any treatment and always make sure a trained professional delivers the treatment if needed.
