Botulinum Toxin for Chronic Migraine
In 2010 Botulinum was licensed in the UK by the by the Medicines and Healthcare products Regulatory Agency for the treatment of chronic migraine. In June 2012 the National Institute of Clinical Excellence recommended “botulinum toxin type A as a possible treatment for preventing headaches in some adults with chronic migraine”
What is botulinum toxin
Botulism was first described in 1817. The bacterium responsible, Clostridium botulinum, produces a number of toxins that paralyse some muscles. A highly dilute preparation of one of these was introduced in clinical practice in the 1970s and 1980s to treat squint and blepharospasm. Since then it has found uses in other areas of medicine including dystonia (including writer’s cramp), post-stroke spasticity, and hyperhidrosis.
Botulinum toxin and headache:
In the mid-1990s a number of people reported improvement in headaches. Clinical trials have subsequently shown that botulinum can help with chronic migraine
How does botulinum toxin work in chronic migraine?
The simple answer is that we don’t know fully.
How is it given?
The treatment consists of approximately 34 injections around the head and shoulder muscles. The needle is very fine indeed and the procedure is usually tolerated very well.
What are the risks?
These will be discussed in detail at your consultation but greatest risk is that the eyebrows will be weakened and may appear to droop. Rarely there is also the risk of making the pain flare up for a few days afterwards. Very rarely people have had double vision and flu like symptoms; these are temporary.
An oxygen mask may be placed over your face. A needle is then placed in the epidural space. A mixture of slow-release steroid and local anaesthetic, or just local anaesthetic, is injected into the epidural space. This procedure takes about 15-20 minutes. After the procedure your blood pressure, pulse and respiration rate may be checked
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