26May 2017

botoxIn today’s media when we hear “Botox” (Botulinum toxin) we often associate it with cosmetic enhancement and the relentless war against ageing within the celebrity and beauty industry. But did you know Botox has proven symptom reduction for many medical conditions?

For instance many people suffering from neuropathic pain, spasticity, myofascial pain, bladder pain and chronic migraine have all found to benefit from a series of Botox injections1,2. Although many conditions are improved with this treatment, the benefits of Botox for Chronic Migraine will be today’s focus.



So, before we discuss Botox as a treatment for chronic migraine, what is “chronic migraine”?

migraneFirst of all, migraine is not just a bad headache. For anyone who has experienced migraine, or, who has witnessed a family member or friend suffering from migraine knows it is an extremely debilitating and incapacitating collection of symptoms which can include some or all of the following:





  • Severe throbbing, pulsating pain, usually on one side of the head (but it can be both)3,4
  • Visual disturbance including blurred vision, sensitivity to light or with the presence of an aura (flashing lights, blind spots, patterns in front of the eyes)3,4
  • Nausea and/or vomiting3,4
  • Sensitivity to sound3,4
  • Tingling or numbness to the face3,4

Symptoms increased by routine physical activity3,4

whoFew people know that migraine is the 6th most disabling illness globally according to the World Health Organization4. The vast majority of those who suffer with migraine are women. While many people experience migraine periodically, over 4 million people experience chronic migraine4. Specialist criteria apply for chronic migraine3 to be diagnosed, including:




  • Headache (not due to to another illness/condition) on at least 15 days of each month for at least 3 months. The headache should include at least 2 of the following:
  • Pain located on one side of head
  • Pulsating quality
  • Moderate to severe pain intensity
  • Symptoms aggravated by routine physical activity
    • And at least 1 of the following:
  • Nausea and/or vomiting,
  • Photophobia (sensitivity to light)
  • Phonophobia (sensitivity to sound)


Due to the debilitating nature of migraine and the development into chronic migraine, effective treatments are essential to reduce pain and symptoms, increase function in daily life (such as the ability to attend work, care for family members, participate in hobbies) and improve overall quality of life for those who suffer with migraine and their families. One such treatment is Botulinum toxin (“Botox”).

What is Botox and where does it come from?

Botox is a drug made from a toxin produced by the bacterium Clostridium botulinum. It works by weakening or paralyzing specific muscles or by reducing or blocking particular nerve pathways. It’s effects can last anywhere from 3 to 12 months depending on the area treated and the individual person5. Strong research exists for the benefits of Botox in the treatment of chronic daily headaches and chronic migraine5,6,7.

In October 2010, the Food and Drug Administration (FDA) approved the use of Onabotulinumtoxin A (Botox) as a treatment strategy for patients with chronic migraine. This approval was based on 2 landmark research trials across America and Europe demonstrating reduced number and intensity of migraine headaches and improved overall quality of life in those treated with Botox6,7.

What is involved?

Like every condition, the team here in the Spine & Pain Institute will complete a thorough assessment, evaluation and create an individualised treatment plan.  Other treatment options may be exhausted prior to discussing or utilising Botox. If Botox is deemed to be an appropriate treatment, the physician will complete a series of specific dose injections outlined by strict and comprehensive guidelines depending on the individual, the site of migraine pain and the symptoms experienced6,7,8.

Are there any side effects?

Like any medications or invasive treatments, there are always associated risks and possible adverse effects. These can include8:

      • Skin tightness
      • A drooping eyelid
      • Pins and Needles/tingling to the area
      • Neck stiffness
      • Facial paresis
      • Muscle weakness
      • Neck pain
      • Muscle spasms


Is it for me?

Firstly, Botox has only been proven for those with chronic migraine, so it is important to establish that you are experiencing chronic migraine and not another condition with similar symptoms. This is why the team of physicians and nurse practitioners will complete a thorough assessment and evaluation. It is crucial that each patient has an informed discussion and consultation surrounding their headaches and all the options for treatment such as medication, lifestyle changes (exercise, stress management, diet, meditation9) discussed before a decision to use Botox is reached.  It is important to be aware, people with particular conditions may be at a higher risk of experiencing some adverse effects mentioned above which is why the Spine & Pain team spend such time discussing and evaluating if Botox is right for you.




    1. Persaud et al 2013 An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions
    2. Wissel et al 2009. European Consensus Table on the use of Botulinum Toxin Type A in Adult Spasticity.  
    3. International Classification of Headache Disorders, 2nd ed. ICHD-II 1.5.1 & 1.6.5
    4. World Health Organisation Classification of Disabling diseases http://www.who.int/mediacentre/factsheets/fs277/en/
    5. Jackson et al 2012. An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions
    6. Aurora et al 2010. OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized placebo controlled phase of the PREEMPT 1 trial.
    7. Diener et al 2010. OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial.
    8. Injection Workbook for Chronic Migraine: Guidance for identifying BOTOX® candidates, the injection
    9. www.migraineresearchfoundation.org