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Botulinum toxin type A for migraine

Botox

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 given by injection into muscles around the head and neck.

  • To be eligible, you must have frequent headaches and have tried other migraine prevention medicines.

  • Injections are typically repeated every 12 weeks if the treatment is successful.

  • Common side-effects include pain at injection sites and muscle pain or weakness.

  • Seek immediate medical help if you experience difficulty swallowing, speaking, or breathing.

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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.

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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  • 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.

  • 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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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

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 is botulinum toxin type A and how does it relate to Botox®?

Botulinum toxin type A is a protein substance derived from a bacterium which primarily interferes with nerve function. Botox® is one of several brand names, alongside others like Alluzience®, Azzalure®, Bocouture®, and Xeomin®, under which botulinum toxin type A is available for medical treatments, including chronic migraine.

Are there specific criteria I need to meet to be eligible for botulinum toxin type A treatment for migraine?

Yes, to be eligible for this treatment for migraine, you must experience headaches for 15 or more days each month, with migraine headaches occurring on at least eight of those days. Additionally, you need to have attempted and found insufficient several other migraine prevention medicines before this treatment will be considered.

How often will I need to receive botulinum toxin type A injections if they are effective for my migraines?

If the treatment is successful in managing your chronic migraines, your doctor will likely recommend that the injections are repeated approximately every 12 weeks.

Are there any specific situations where I should inform other healthcare professionals about my botulinum toxin type A treatment?

Yes, if you are planning to have an operation or dental treatment, it is important to inform the person carrying out the procedure that you have received botulinum toxin type A injections.

What should I do if I experience rare but serious side effects like difficulty swallowing or breathing after treatment?

If you experience any serious side effects such as difficulty swallowing, speaking, or breathing, you should seek immediate medical attention. Contact your doctor straightaway or go directly to your local accident and emergency department.

Further reading and references

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About the authorView full bio

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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

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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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