Treatment with Botulinum toxin (Botox) for migraine and headache

What is Botulinum toxin?

Botulinum toxin is a neurotoxin produced by a bacterium. The substance blocks the connection between nerve and muscle. It is used as a medical treatment for migraines and for increased muscle activity, including in patients suffering from painful muscle spasms, but you may know it best from its cosmetic use as a treatment for wrinkles.

How does Botulinum toxin work?

It is believed that when Botulinum toxin is injected, it blocks pain signals and thereby indirectly prevents the development of a migraine attack. However, the exact mechanism has not been fully clarified by research.

Botulinum toxin treatment procedure

Treatment with botulinum toxin involves injecting very small amounts of the toxin into 31 different sites in the muscles around your head, neck, and shoulders. If the pain is worse in a specific area of your head, you may receive slightly more injections in the area(s) where you have the most pain. This treatment procedure is known as the PREEMPT protocol and is the method that has been proven effective in studies of more than 1,000 migraine patients. We recommend that you ask your healthcare provider if they follow this protocol.

The treatment itself must be performed by qualified healthcare professionals and takes approximately 10 minutes. If there is a good effect, the treatment can be repeated every 3–4 months.

Side effects of Botulinum toxin

After the treatment, there may be slight discomfort and swelling at the injection sites (2), but this usually disappears within a few hours.

It is recommended to avoid rubbing the treated areas for the first 24 hours. Side effects can include fever and flu-like symptoms, a drooping eyelid, local muscle weakness, muscle pain, neck pain, and rash, but these are fortunately rare.

In very rare cases, serious side effects such as muscle weakness, difficulty swallowing, and pneumonia can occur due to the spread of the toxin. If you experience such symptoms, you should seek medical attention immediately.

Who should not receive the treatment

You should not receive treatment if:

• You have previously reacted negatively to treatment with botulinum toxin type A.
• You have an infection in one or more of the areas where you are to receive injections.
• You are pregnant or breastfeeding.
• You suffer from chronic diseases that cause muscle weakness.
• You have a fever.

Sources:

1. Danish Headache Society, Reference Program 2020 (2020), https://dhos.dk/wp-content/uploads/2020/06/2932-Referenceprogram_2020_final_web-24.06.20.pdf
2. National Knowledge Center for Headache - Treatment with Botulinum toxin https://videnomhovedpine.dk/sites/default/files/paragraph/field_download/NVH_Behandlingsark_botox.pdf
3. Sundhed.dk, Referral criteria - referral of headache patients (26.01.2021), https://www.sundhed.dk/sundhedsfaglig/information-til-praksis/syddanmark/almen-praksis/patientbehandling/patientforloeb/visitation/ouh/visitationskriterier-henvisning-af-hovedpinepatienter/