It was announced this week that Botox®, botulinum toxin type A has received approval from the UK Medicines and Healthcare products Regulatory Agency (MHRA) as a preventive treatment for chronic migraine headaches.
I have been using Botox® to treat migraine sufferers for over 10 years, both privately through Medizen Clinics and through the NHS at my practice in Birmingham
The approval comes after data was examined from a clinical trial of over 1,300 patients which showed success in reducing the frequency of the headaches suffered by the individuals.
It is estimated that 700,000 people in the UK are affected by chronic migraines; however the only patients who will be eligible to receive Botox® treatment on the NHS under the new approval guidelines are those who suffer from headaches for at least 15 days out of every month, half of which come with migraine symptoms. Thus it is likely that most sufferers will still need to seek this treatment privately, but this approval does go a long way towards highlighting the efficacy of this treatment to the wider population.
The exact understanding of why Botox® works effectively to treat migraines is still somewhat unknown.
When used in a cosmetic indication it acts as a muscle relaxant by blocking the signal from the nerve to the muscles of the face (by temporarily affecting the release of a neurotransmitter called acetycholine) so that they do not move during certain dynamic facial movements such as frowning, thus eliminating dynamic wrinkles.
In the case of migraine prevention, where the drug is placed through injections into the forehead, sides of the head and rear of the neck it is thought that the Botox® may work to block the pain signals associated with the headaches, specifically in relation to muscle spasms, by reducing the activity of certain muscles.
In the clinical trial, published in the journal Headache, participants were given 5 treatment sessions of Botox® or a placebo injection into specific muscles in the head and neck every 12 weeks. After 24 weeks, it was noted that those treated with Botox® had fewer migraine days than those who were given the placebo. At the one year point, almost 70% of those who received Botox® had a 50% reduction in the number of migraines that they experienced compared to before they started the trial.
It should be highlighted that this treatment does not represent a ‘cure’ for migraines but a way of managing the onset and symptoms for chronic sufferers via regular treatment sessions every 3 to 6 months. However, gaining a licence for this use recognises the extraordinary variety of applications of this medication. It should also be noted that this is a medical indication, and is not something that should be performed by non-medical personnel outside a specialist clinic or hospital.