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Botox for migraine: What to expect

Past: Ria Bhola, Headache Nurse Specialist, The Migraine Trust

23rd November 2021

The Migraine Trust information page describes Botox every bit a migraine handling, looking at who it might be suitable for, when to consider it and how to admission the treatment if you have chronic migraine.

In this weblog we look at what to look at the treatment session, how to prepare for the treatment and the immediate later on care.

What is Botox?

Botox is useful to treat and prevent migraine. The total proper name is Botulinum toxin A.

It is likewise used to treat a range of conditions such as dystonia, excessive sweating, an overactive bladder, and is used cosmetically.

It is given by injection into specific areas where it causes those muscles to relax but likewise connects with the nerves in those muscles to help reduce pain.

Whatsoever do good and side effects of Botox are temporary and volition article of clothing off completely by 12 weeks. If information technology is effective, you lot can unremarkably have it again at 12 weeks.

Who is it for?

Botox is licensed and approved in the U.k. for people with chronic migraine (at least xv days of headache a month, viii of which are migraine). Your neurologist or headache specialist volition offering this treatment if you accept already tried three migraine preventive treatments without them helping to improve your migraine. They will as well want to check that yous are not using painkillers and triptans as well frequently.

What to look at the clinic

You lot should bring forth your headache diary to the dispensary appointment. Y'all should tape how many days you lot have migraine and headache, equally well as the number of days (not doses) yous employ a pain relief treatment.

Many people are understandably anxious about having the 31 injections on their head, neck and shoulders. However, virtually are surprised at how well they tolerate these very modest, superficial injections. The injections are placed with a very fine needle in the brow, temple area, dorsum of the head, upper neck and shoulders.

The bodily injections can be done in x-15 minutes. However, earlier the procedure is done, your nurse or md will accept some time to await at your headache diary, talk over your headache design, explain the procedure (including potential benefits and side effects) and allow you lot time to inquire questions.

For most people the injections are washed while y'all are sitting (but you tin can prevarication downward if preferred or if you feel faint). The injections might be uncomfortable and sting for a few seconds, but this settles chop-chop.

Information technology is best to come up without make-upwardly but the skin will be cleaned prior to the injections, to reduce the chances of infection.

Later care

You will exist able to render home on your ain, but some people prefer to have someone accompany them, especially on the first occasion. It is best to take the balance of the day off, just it is not a requirement to have boosted time off following the procedure.

To avert infection and allow the complete assimilation of the drug into the areas injected, it is all-time to avoid the following during the first 24 hours:

  • Vigorous exercise (east.g. gym, jogging)
  • Pilus washing – y'all may want to wash your hair the day before the appointment
  • Skin cleansing in areas injected
  • Massages and extreme heat such every bit spas

The areas injected might feel bruised or tender for a few days and y'all may besides notice your migraine symptoms are temporarily more astringent or you lot may accept a migraine set on in the days following the handling. You tin can use your usual acute treatment (e.g. painkillers, triptans) every bit needed during this period. The benefit will commonly develop a calendar week or two afterwards the injections.

Since Botox is given as two separate treatments, 3 months apart, the full upshot might only be felt later on the second set of injections. And then a lack of effect later the first treatment does non hateful that the treatment is not working. Remember to continue a daily headache diary and accept this back to the clinic for your adjacent engagement.

Summary of possible side effects:

  • A temporary worsening of your migraine for some days or a migraine set on on the twenty-four hours of handling. These should exist treated with your usual medication.
  • The peel is cleaned before the injections are done just as with all injections, infection, bleeding, tenderness, and bruising are possible where the injections are placed. This will usually be minor and concluding no more than than a few days.
  • Drooping of the eyelid or forehead. Information technology is of import not to rub the areas where the injections were done for the get-go 24 hours. Cleaning the forehead, washing the hair, applying make-up is best avoided until the drug is fully absorbed during that offset day.
  • Small-scale changes to expression lines in the forehead are possible.
  • Weakness and hurting in the neck and shoulders which tin can last a few weeks. If this happens you lot should let your dispensary know and they may avoid injecting those areas in futurity handling sessions.
  • If you have found no benefit after the second handling, a 3rd handling may be given, or an culling volition be considered.