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Botulinum toxin type A for migraine

Botox

Peer reviewed by Sid DajaniLast updated by Michael Stewart, MRPharmSLast updated 19 Sept 2023

Meets Patient’s editorial guidelines

Botulinum toxin type A is a specialist treatment for migraine.

To be eligible for this treatment you must have headaches for 15 or more days each month, with migraine headaches being on at least eight of these days.

It will be given by multiple injections into the muscles around your head and neck.

If you experience any difficulty swallowing, speaking, or breathing after the treatment, speak with your doctor immediately.

At a glance

  • Botulinum toxin type A is a neurotoxin used to prevent chronic migraine headaches.

  • It is offered when other preventive headache medicines have not worked.

  • To be eligible, you must have headaches on 15 or more days a month, with 8 days being migraine.

  • Injections are given into muscles around your head and neck by a trained doctor.

  • Treatment is usually repeated every 12 weeks if it is successful.

  • Tell your doctor if you have muscle problems, swallowing or breathing difficulties, or an infection.

  • Seek medical help immediately for difficulty swallowing, speaking, or breathing after treatment.

This summary has been automatically generated from the article content to help readers quickly understand the key points.

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About botulinum toxin type A

Type of medicine

A bacterial neurotoxin

Used for

To prevent headaches associated with chronic migraine in adults

Also called

Onabotulinumtoxin A (in US); Alluzience®; Azzalure®; Bocouture®; Botox®; Nuceiva®; Xeomin®

Available as

Injection

Botulinum toxin type A is a protein substance which is produced by the bacterium Clostridium botulinum. It is a neurotoxin which means that it interferes with the way nerves work. To be eligible for this treatment you must have headaches for 15 or more days each month, with migraine headaches being on at least eight of these days. You must also have tried several other medicines to prevent migraine before this treatment is prescribed for you.

Botulinum toxin type A is thought to work in chronic migraine by relaxing muscles and by blocking the pain signals which are involved in the development of a migraine. These actions may have the effect of stopping a migraine headache from being triggered.

Botulinum toxin injections are also used for other reasons (including cosmetic purposes, muscle spasms, bladder problems, and excessive sweating). This leaflet does not cover the use of botulinum toxin type A in these ways.

Before being treated with botulinum toxin type A

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Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before being treated with botulinum toxin type A for migraine, make sure that your doctor knows:

  • If you are pregnant, trying for a baby or breastfeeding.

  • If you have an infection or any swelling near any of the areas that will be injected.

  • If you have any muscle problems, particularly any muscle weakness.

  • If you have ever had any difficulty in swallowing or with your breathing.

  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

  • If you have ever had an allergic reaction to a medicine.

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How you will be given botulinum toxin type A

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  • Before you start the treatment, ask to read the manufacturer's printed information leaflet from inside the pack. It will give you more information about Botox® and will provide you with a full list of the side-effects which you may experience from having it.

  • You will be given botulinum toxin type A by a doctor who is trained in the use of this treatment. It will be injected into the muscles around your head and neck in several different places.

  • If the treatment proves successful for you, your doctor is likely to recommend that it is repeated every 12 weeks.

Getting the most from your treatment

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  • If you are having an operation or dental treatment, tell the person carrying out the treatment that you have received botulinum toxin type A.

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Can botulinum toxin type A cause problems?

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Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with botulinum toxin type A. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects may occur following a treatment session even if you have been free from side-effects on previous treatments. You should speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common Botox® side-effects (these affect fewer than 1 in 10 people)

What can I do if I experience this?

Pain at the sites where you have been injected, neck and muscle pain or stiffness, muscle weakness, skin rash and itching

These should soon pass, but if any becomes troublesome, speak with your doctor

Worsening of headache or migraine

Speak with your doctor about this

Eyelid drooping or swelling, paralysis of the face

Speak with your doctor about this

Important: if you experience any difficulty swallowing, speaking, or breathing, speak with your doctor immediately or go to your local accident and emergency department straightaway.

If you experience any other symptoms which you think may be due to the treatment, speak with your doctor or pharmacist for further advice.

Important information about all medicines

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Important information about all medicines

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

If you buy any medicines, check with a pharmacist that they are safe to use alongside this treatment.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Report side effects to a medicine or vaccine

If you experience side effects, you can report them online through the Yellow Card website.

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Unsure about mixing medicines?

Check for possible interactions between medicines, supplements and foods before taking them together.

Frequently asked questions

What specifically is botulinum toxin type A and where does it come from?

Botulinum toxin type A is a protein substance. It is produced naturally by a bacterium called Clostridium botulinum. It works as a neurotoxin, meaning it affects how nerves function.

How does botulinum toxin type A help to prevent chronic migraine headaches?

It is thought to work by relaxing muscles and blocking the pain signals involved in migraine development. These actions may help prevent a migraine headache from starting.

Who can receive botulinum toxin type A injections for migraine prevention?

You must experience headaches for 15 or more days each month, with at least eight of those being migraine headaches. Also, you need to have tried several other migraine prevention medicines unsuccessfully before this treatment can be prescribed.

Are there other uses for botulinum toxin injections besides chronic migraine?

Yes, botulinum toxin injections are used for various other conditions including cosmetic purposes, muscle spasms, bladder problems, and excessive sweating. However, this article focuses specifically on its use for chronic migraine prevention.

How often would I need to receive these injections if the treatment is effective?

If the treatment works well for you, your doctor will likely recommend that the injections are repeated every 12 weeks.

What should I do if I experience side-effects like pain or muscle stiffness after the injection?

Pain at the injection sites, neck and muscle pain or stiffness, muscle weakness, skin rash, and itching should typically pass soon. If any of these become troublesome or continue, you should speak with your doctor.

What are some of the more serious side-effects I should be aware of?

Serious side-effects can include eyelid drooping or swelling, or paralysis of the face; you should speak with your doctor about these. More urgently, if you experience any difficulty swallowing, speaking, or breathing, you should contact your doctor immediately or go straight to Accident and Emergency.

These questions and answers have been generated from the information in this article.

Further reading and references

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About the authorView full bio

Author image

Michael Stewart, MRPharmS

Medicine Leaflet Review Manager – Contractor, Pharmacist

BPharm (Hons), MRPharmS

Michael is a community pharmacist practicing in the Midlands and South Yorkshire with more than 20 years’ experience advising on medicines and medical conditions. He has a strong background in healthcare training, having produced and delivered training courses for pharmacy teams and staff of residential care settings, including nurses. He has also contributed to pharmacy advisory boards for the management of low acuity conditions in the community.

About the reviewer

Author image

Sid Dajani

Sultan Dajani qualified at the London School of Pharmacy in 1994 and became the youngest elected member of the Royal Pharmaceutical Society council since its founding in 1842.

Article history

The information on this page is written and peer reviewed by qualified clinicians.

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