Botox injections associated with only modest benefit for chronic migraine and daily headaches

April 24, 2012

Although botulinum toxin A ("Botox") injections are U.S. Food and Drug Administration approved for preventive treatment for chronic migraines, a review and analysis of previous studies finds a small to modest benefit for patients with chronic migraine headaches and chronic daily headaches, although botox injections were not associated with greater benefit than placebo for preventing episodic migraine or chronic tension-type headaches, according to an article in the April 25 issue of JAMA.

"Migraine and tension-type headaches are common. Although up to 42 percent of adults experience tension-type headaches sometime in their life, most do not seek medical advice. Migraines are less common, with a worldwide prevalence between 8 percent and 18 percent, but are associated with greater disability. are responsible for $1 billion in medical costs and $16 billion in lost productivity per year in the United States alone," according to background information in the article. 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. However, the on botulinum effectiveness for headaches has been mixed.

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 A with reducing headache frequency when used for of migraine, tension, or chronic daily headaches in adults. For 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. The researchers identified 27 randomized placebo-controlled trials that included 5,313 and 4 randomized comparisons with other medications that met study inclusion criteria.

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 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).

Compared with placebo, botulinum toxin A was associated with a greater frequency of blepharoptosis (drooping of the upper eyelid), skin tightness, paresthesias (a prickly, tingling sensation), neck stiffness, muscle weakness, and neck pain.

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 topiramate (1.4 headaches per month) or amitriptyline (2.1 headaches per month) for prophylaxis against chronic migraine headaches. "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)," the authors write.

"Our analyses suggest that botulinum toxin A may be associated with improvement in the frequency of chronic migraine and chronic daily headaches, but not with improvement in the frequency of episodic migraine, chronic tension-type headaches, or episodic tension-type headaches. However, the association of botulinum toxin A with clinical benefit was small. 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 ."

More information: JAMA. 2012;307[16]:1736-1745.

Related Stories

Recommended for you

Investigators may unlock mystery of how staph cells dodge the body's immune system

September 21, 2017
For years, medical investigators have tried and failed to develop vaccines for a type of staph bacteria associated with the deadly superbug MRSA. But a new study by Cedars-Sinai investigators shows how staph cells evade the ...

Superbug's spread to Vietnam threatens malaria control

September 21, 2017
A highly drug resistant malaria 'superbug' from western Cambodia is now present in southern Vietnam, leading to alarming failure rates for dihydroartemisinin (DHA)-piperaquine—Vietnam's national first-line malaria treatment, ...

Individualized diets for irritable bowel syndrome better than placebo

September 21, 2017
Patients with irritable bowel syndrome who follow individualized diets based on food sensitivity testing experience fewer symptoms, say Yale researchers. Their study is among the first to provide scientific evidence for this ...

A dose of 'wait-and-see' reduces unnecessary antibiotic use

September 21, 2017
Asking patients to take a 'wait-and-see' approach before having their antibiotic prescriptions filled significantly reduces unnecessary use, a University of Queensland study has shown.

Groundbreaking investigative effort identifies gonorrhea vaccine candidates

September 19, 2017
Researchers at Oregon State University have identified a pair of proteins that show promise as the basis for a gonorrhea vaccine.

Snail fever progression linked to nitric oxide production

September 14, 2017
Bilharzia, caused by a parasitic worm found in freshwater called Schistosoma, infects around 200 million people globally and its advance can lead to death, especially in children in developing countries.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.