30 May 2003
Botox injections are worth considering as a preventive treatment for some people with migraine, according to a leading Australian neurologist.
Professor Mark Cook, director of neurology at St Vincent's Health, Melbourne, was commenting after 3 successful case reports in The New Zealand Medical Journal (2003; 116).
(Botox is the brand name of an injection of the naturally occurring nerve toxin botulinum toxin type A. It is currently approved for use in Australia to treat various nerve disorders, as well as cosmetic treatment of frown lines. It is not currently approved for treatment of migraines.)
Professor Cook said the approach sounded interesting, even though the procedures were performed by a cosmetic physician without neurologist involvement.
'It is very early days, but it is at least worth considering — although pretty expensive and without Medicare rebate.'
Professor Cook said that GPs might recommend Botox injections for patients who had unsuccessfully tried other treatments, but they needed to advise patients that there was no guarantee and that the work was preliminary.
He suggested referral to a neurologist with experience in injecting Botox. The injections might cause temporary weakness in the face or neck, he said.
NZ cosmetic physician Dr Theresa Cattin said that encouraging clinical evidence, mainly case studies, was accumulating regarding the efficacy of botulinum toxin type A in migraine prevention, including a double-blind, randomised study that reported markedly reduced symptoms (published in the journal Headache 2000; 40: 455-50).
Botox injections were thought to help in 2 ways, Dr Cattin said: via muscle relaxation and by its anti-nociceptive (anti-pain perception) action.
The anti-nociceptive action is believed to be the most important pain-reduction mechanism, as Botox inhibits the release of a chemical involved in pain perception from the trigeminal nerve (the nerve that provides sensation to the face and movement in the muscles of the jaw that are associated with chewing).
Last Reviewed: 02 June 2003