Botox treatment for migraine

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What is this information about?

This information is about botox (botulinum toxin A) treatment for people who have chronic migraine (more than eight migraines a month).

It explains:

• who can have botox treatment for migraine
• how botox works to treat migraines
• what will happen when you are having your treatment
• how you will know if the treatment is working
• what side effects you may get from botox treatment
• who the members of the Headache Team are.

Why have I been given this information?

You have been given this information because your Consultant has referred you for botox injections as you have chronic migraine. Reading this information will help you to know what to expect from your treatment.

How does botox work to treat chronic migraine?

Botox can help to reduce how often you have migraines and how bad they are. It interrupts pain signals that go between your brain and the nerve endings that connect to your muscles.

How often will I need to have botox treatment?

You are likely to need botox treatment every three months. The nerve endings are disrupted by the botox treatment but the body soon grows new ones. This means you will need regular treatment.

What will happen on the day of my botox treatment appointments?

• A clinical nurse specialist will talk with you about:
  • how often you are getting headaches and migraines
  • how your migraines feel and what symptoms they give you
  • what will happen when you have your botox injections
  • any risks from having botox treatment
  • any concerns, worries or questions you have.
• We will give you your botox injections.
  • On your first and second appointments you will be given a starting dose of 155 units of botox spread across 31 injections. These will be in the muscles just under your skin on your face, scalp, and shoulders. We use a very fine needle for the injections.

• Then,
  • On your third appointment, the clinical nurse specialist will assess you to see if you require more injections. Some patients do not need additional injections. The maximum dose of botox that you can have is 195 units, which is 39 injections.

Is having botox injections uncomfortable?

Having botox injections can cause discomfort but usually only takes around five minutes. Please tell us if you would like us to go more slowly and we will give you as much time as you need.

How will I know if botox is the right treatment for me?

To be eligible for this treatment you must:

• have a diagnosis of chronic migraine (at least 8 migraines and 15 headaches per month)
• have tried at least three other medicines which have not worked for you

We will know that the treatment is working for you if after two to three treatments you have at least a 30% reduction in migraine days and your pain is less severe.

Do keep a daily headache diary starting from as soon as you know you will be having botox treatment. Keep your diary over the whole period in which you are having your botox treatments.

You will need to record:

• every day you have a migraine and a headache
• a pain score for each day
• every day that you take a painkiller
• if you have a menstrual cycle (period)

This will help you and us to decide if the treatment is working.

The Migraine Trust say that for people having botox treatment for chronic migraine:

• one in four people get good results within the first two treatments
• half of the people need more treatments or higher doses
• one in four people may not get much better

What happens if botox treatment does not work well for me?

We will refer you back to your Consultant who will try to find a treatment that will work better for you. You will still be under the care of the Specialist Headache Team and do not have to re-join the waiting list for further treatment.

Are there any side effects of botox treatment for chronic migraine?

Yes. As with most medicines there are some side effects. These may include:

• drooping of the eyelid or eye. This is called ptosis. There is a small chance (around 1 in 50 people) that you may get ptosis. It is likely to wear off within 2 weeks.
• having headaches more often or headaches which are worse than usual. This is short term and you should see benefits from the treatment after 2 to 3 weeks. Some people may need to have had two treatments before they see any benefit. 
• neck or shoulder stiffness. This should wear off after 2 to 3 weeks.  
• pain and bleeding at the injection site during the procedure. This should stop almost straight away. 
• raised, itchy lumps where the botox has been injected which may last for 24 to 48 hours (one to two days).  

Can I have botox injections if I am pregnant or breastfeeding?

If you are pregnant or breastfeeding please tell a member of the Headache Service team.  We advise that you stop having botox treatment if you are planning to conceive, are pregnant or breastfeeding. Your headache service can discuss other treatments for you.

Does botox contain any blood products?

Yes. Botox contains human albumin which you may prefer not to have.

Who should I contact if I have any questions or concerns about botox treatment for chronic migraine after I have read this information?

Please speak to your referring clinician.