Menu
08/02/2011
Botox Offers Little Help In Chronic Migraine
The popular anti-wrinkle jab, Botox, is unlikely to offer much benefit in its most recently licensed use, as a treatment for chronic migraine, says the new look Drug and Therapeutics Bulletin (DTB).
Botulinum toxin is a neurotoxin derived from the bacterium Clostridium botulinum. It is used as a treatment for various conditions involving muscle spasm and is available in several formulations. These include Botox, which is widely used, though not actually licensed, for the smoothing out of facial wrinkles.
Botox has now been licensed for use to relieve the symptoms of chronic migraine as a series of regular injections into up to 39 sites in the head and neck muscles. How it is supposed to work in chronic migraine has not been clearly established, but this action appears distinct from Botox’s well known paralysing effect on muscles. Each treatment with Botox for chronic migraine costs around £276 and the injections have to be given every 12 weeks.
Each year, around 3% of migraineurs who have episodic headaches develop chronic migraine, frequently accompanied by reduced ability to function and impaired quality of life.
DTB considers the published evidence on Botox’s effectiveness as a treatment for chronic migraine is limited and unconvincing. And, crucially, Botox leads to worsening of headache symptoms in around one in 10 people, with a similar proportion developing itching, rash, pain, stiffness and muscles spasms, it says.
Rarely, Botox can prompt anaphylactic shock. And despite screening and control procedures, the possibility of transmitting an infection with Botox cannot be ruled out entirely, because the drug contains human serum albumin.
The UK’s drugs regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), which green-lighted the move, said that Botox offered a “unique approach” to the treatment of chronic migraine. Botox avoided the systemic side effects of tablets and had a better safety profile, the agency said, adding that its efficacy was likely to improve over time with repeated treatment sessions.
But DTB points out that some headache specialists have criticised the evidence on which the MHRA reached its conclusions. They say that the diagnosis of chronic migraine used in the trials was incorrect as almost two thirds of trial participants overused headache treatments. This is important, because medication overuse headache, in which headache treatments end up causing rather than relieving headache, rules out the diagnosis of chronic migraine, according to international definitions.
DTB concluded: “These discrepancies and the limited evidence of benefit make it difficult for us to see a place for botulinum toxin A as treatment for chronic migraine.”
(BMcN/GK)
Botulinum toxin is a neurotoxin derived from the bacterium Clostridium botulinum. It is used as a treatment for various conditions involving muscle spasm and is available in several formulations. These include Botox, which is widely used, though not actually licensed, for the smoothing out of facial wrinkles.
Botox has now been licensed for use to relieve the symptoms of chronic migraine as a series of regular injections into up to 39 sites in the head and neck muscles. How it is supposed to work in chronic migraine has not been clearly established, but this action appears distinct from Botox’s well known paralysing effect on muscles. Each treatment with Botox for chronic migraine costs around £276 and the injections have to be given every 12 weeks.
Each year, around 3% of migraineurs who have episodic headaches develop chronic migraine, frequently accompanied by reduced ability to function and impaired quality of life.
DTB considers the published evidence on Botox’s effectiveness as a treatment for chronic migraine is limited and unconvincing. And, crucially, Botox leads to worsening of headache symptoms in around one in 10 people, with a similar proportion developing itching, rash, pain, stiffness and muscles spasms, it says.
Rarely, Botox can prompt anaphylactic shock. And despite screening and control procedures, the possibility of transmitting an infection with Botox cannot be ruled out entirely, because the drug contains human serum albumin.
The UK’s drugs regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), which green-lighted the move, said that Botox offered a “unique approach” to the treatment of chronic migraine. Botox avoided the systemic side effects of tablets and had a better safety profile, the agency said, adding that its efficacy was likely to improve over time with repeated treatment sessions.
But DTB points out that some headache specialists have criticised the evidence on which the MHRA reached its conclusions. They say that the diagnosis of chronic migraine used in the trials was incorrect as almost two thirds of trial participants overused headache treatments. This is important, because medication overuse headache, in which headache treatments end up causing rather than relieving headache, rules out the diagnosis of chronic migraine, according to international definitions.
DTB concluded: “These discrepancies and the limited evidence of benefit make it difficult for us to see a place for botulinum toxin A as treatment for chronic migraine.”
(BMcN/GK)
Related UK National News Stories
Click here for the latest headlines.
11 March 2004
Reid unveils plan to help sufferers of chronic diseases
A new initiative to help people suffering from long-term chronic diseases like asthma and diabetes has been unveiled by the Health Secretary today. Under the plans, specialist teams across the country will provide advice, care and treatment for chronic disease – often cutting out the need for visits to GPs and hospitals.
Reid unveils plan to help sufferers of chronic diseases
A new initiative to help people suffering from long-term chronic diseases like asthma and diabetes has been unveiled by the Health Secretary today. Under the plans, specialist teams across the country will provide advice, care and treatment for chronic disease – often cutting out the need for visits to GPs and hospitals.
07 May 2013
Breakthrough Reveals New Treatment For Chronic Back pain
A medical breakthrough has revealed that many of the worse cases of chronic back pain are caused by bacterial infection, and could be treated with antibiotics.
Breakthrough Reveals New Treatment For Chronic Back pain
A medical breakthrough has revealed that many of the worse cases of chronic back pain are caused by bacterial infection, and could be treated with antibiotics.
27 May 2009
NHS Recommends Acupuncture For Patients With Chronic Back Pain
The National Institute for Health and Clinical Excellence (NICE) has recommended, for the first time, complementary therapies to treat chronic back pain on the NHS.
NHS Recommends Acupuncture For Patients With Chronic Back Pain
The National Institute for Health and Clinical Excellence (NICE) has recommended, for the first time, complementary therapies to treat chronic back pain on the NHS.
24 July 2003
Tories slam 'chronic' Brown over Inland Revenue
Shadow Work and Pensions Secretary David Willetts has slammed what he described as “chronic mismanagement at the Treasury”, following the Treasury Select Committee’s damning indictment of failures at the Inland Revenue yesterday.
Tories slam 'chronic' Brown over Inland Revenue
Shadow Work and Pensions Secretary David Willetts has slammed what he described as “chronic mismanagement at the Treasury”, following the Treasury Select Committee’s damning indictment of failures at the Inland Revenue yesterday.
14 December 2004
Risk of stroke 'double' for migraine sufferers, says BMA
Migraine sufferers are twice as likely to suffer a stroke than those who do not experience migraines, according to a report in this week's British Medical Journal. In the first review of its kind, researchers in Canada and the US looked at 14 studies which investigated an association between stroke and migraine.
Risk of stroke 'double' for migraine sufferers, says BMA
Migraine sufferers are twice as likely to suffer a stroke than those who do not experience migraines, according to a report in this week's British Medical Journal. In the first review of its kind, researchers in Canada and the US looked at 14 studies which investigated an association between stroke and migraine.
-
Northern Ireland WeatherToday:A showery start with outbreaks most frequent north of Lough Neagh and through the morning, before dwindling during the afternoon as the northwest breezes ease and brighter spells of weak sunshine prosper. Maximum temperature 8 °C.Tonight:A dry night, save for a few light showers around the coasts, with prolonged clear spells and light winds bringing a frosty dawn for many in central and southern parts. Minimum temperature -3 °C.
