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Treating chronic migraines with botulinum toxin

02 December 2021
Volume 10 · Issue 10


Migraine is a common condition that causes significant morbidity. It is often divided into acute and chronic, but there can be overlap between those who have variable frequency acute episodes and those who have chronic migraine with 15 headache-associated days per month. Botulinum toxin is a prophylactic treatment licensed for chronic migraine, where it has been shown to be an effective and safe treatment. It requires approximately 200 units per treatment session, usually at 3-month intervals. The protocols allowing NHS treatment strictly limit its use. Patients may seek this on a private basis, and suitably qualified aesthetic clinicians who are Care Quality Commission-registered could reasonably treat patients.

Migraine is primarily a headache disorder, but there are many symptoms associated with the condition and they are frequently debilitating. In the UK, there is an estimated 190000 attacks per day and 25 million lost workdays per year (Steiner et al, 2003).

In acute migraine, the episode lasts 4–72 hours. There is usually a prodromal period prior to the headache that might consist of symptoms such as irritability, tiredness, dizziness, hunger, nausea, or yawning, followed by an often-unilateral headache and, sometimes, aura, such as tingling and visual and speech disturbance. A recovery period, which can last up to a few days, will then take place, followed by a clear period with no symptoms (Johns Hopkins Medicine, 2021).

Despite being episodic, acute migraine is debilitating, and, while two episodes per month will not be classified as chronic migraine, it can still have a dramatic effect on a patient's life. Research into the effects of botulinum toxin on these conditions is mainly focused on chronic migraine syndrome. However, patients with frequent acute migraine attacks who do not fulfil the criteria for chronic migraine may benefit from botulinum toxin treatment, although specific evidence for this is not currently available.

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