Can Botox Stop Migraines?

February 9, 2011

Recently, the effectiveness of Botox as a pain management tool has been called into question.

Botox is no one-trick-pony. A neurotoxin derived from the Clostridium botulinum germ, Botox is primarily viewed as a cosmetic drug and acts by paralyzing the muscles that cause wrinkles in the face. Naturally, it was surprising when the compound was found to have properties to lessen—if not obliterate—the painful consequences of chronic migraines.

Recently, however, its effectiveness as a pain management tool has been called into question.

The British journal Drug and Therapeutics Bulletin issued a report today stating that there was "limited evidence" sustaining the use of Botox to treat chronic migraine, which it has been approved of in the UK, US, and other countries. In the United States and Australia, authorization for Botox to be used to remedy migraines must be sought on a patient-by-patient basis, as it is an "off-label" treatment.

"The evidence is clear that it works; however, the benefit is small," said Professor Paul Rolan, Professor of Clinical Pharmacology, University of Adelaide, and consultant, Pain Management Unit, Royal Adelaide Hospital.

Rolan treats about half-a-dozen migraine sufferers every year with Botox and asserts that it had fewer side effects than conventional drugs to treat chronic migraine. Even such, Botox is still viewed as a "last resort" treatment, which may partially be due to the high-end price tag that comes along with the drug: the dose effective against migraines in Rolan’s exprience averaged $1000 (in unsubsidized costs to the patient).

Professor Rolan argued, "a lot of people say they would willingly pay a thousand dollars if you could get rid of my migraines for three months," but admitted that it can be hard to recommend this treatment when "you might need to treat up to ten people to see one that has the benefit."

The treatment, which is now authorized in Britain, the US and other areas to relieve chronic migraines, is administered by regular injections to up to 39 locations in the head and neck muscles.

Experts from the journal surveyed the collection of migraine sufferers who used the drug in a clinical trial. Their report added it was impossible to fully exclude or measure the likelihood of other risks from Botox, including the danger of infection from the protein human serum albumin, an element of the drug's formula.

As such, the journal concluded that these "discrepancies and the limited evidence of benefit make it difficult for us to see a place for botulinum toxin A as treatment for chronic migraine.”

It is also not completely understood how the drug Botox reduces the occurrence of a migraine.