A new review and analysis of previous studies has found that botulinum toxin A (“Botox”) injections have a small to modest benefit for those with chronic migraine headaches and chronic daily headache.
Botulinum toxin A injections were first proposed as headache treatment when it was observed that patients with chronic headaches receiving cosmetic botulinum injections experienced headache improvement, prompting several case series that suggested benefit. Jeffrey L. Jackson, M.D., M.P.H., of the Medical College of Wisconsin, Milwaukee, and colleagues performed a review and meta-analysis to assess the association of botulinum toxin A with reducing headache frequency when used for preventive treatment of migraine, tension, or chronic daily headaches in adults. In the study, headaches were categorized as episodic (less than 15 headaches per month) or chronic (15 or more headaches per month) migraine and episodic or chronic daily or tension headaches. A total of 27 randomized placebo-controlled trials which included 5,313 study participants and 4 randomized comparisons with other medications were included in the study.
Pooled analyses of the data suggested that botulinum toxin A was associated with fewer headaches per month among patients with chronic daily headaches (1,115 patients, -2.06 headaches per month) and among patients with chronic migraine headaches (1,508 patients, -2.30 headaches per month). There was no significant association between use of botulinum toxin A and reduction in the number of episodic migraine (1,838 patients, 0.05 headaches per month) or chronic tension-type headaches (675 patients, -1.43 headaches per month).
However, it is important to note that when compared to a placebo Botox was associated with a greater frequency of blepharoptosis (drooping of the upper eyelid), , paresthesias (a prickly, tingling sensation), neck stiffness, skin tightness, neck pain, and muscle weakness.
In the 4 trials that compared botulinum toxin A with other treatment modalities, botulinum toxin A was not associated with reduction in headache frequency compared with amitriptyline (2.1 headaches per month) or topiramate (1.4 headaches per month) as a preventative against chronic migraine headaches. The authors state:
“Botulinum toxin A was not associated with a reduction in headache frequency vs. valproate in a study of patients with chronic and episodic migraines (0.84 headaches per month) or in a study of patients with episodic migraines (0.3 headaches per month). Botulinum toxin A was associated with a greater reduction in average headache severity than methylprednisolone in a single trial among patients experiencing chronic tension-type headaches (-2.5 headaches per month).”
Hence the results from the study indicate:
“Botulinum toxin A was associated with a reduction in the number of headaches per month from 19.5 to 17.2 for chronic migraine and from 17.5 to 15.4 for chronic daily headaches.”
Journal Source: J. L. Jackson, A. Kuriyama, Y. Hayashino. Botulinum Toxin A for Prophylactic Treatment of Migraine and Tension Headaches in Adults: A Meta-analysis. JAMA: The Journal of the American Medical Association. 2012. 307. 16.
Great article. Excellent information. I would love to see further research on this in a larger study.