Migraines chroniques : l'efficacité de la toxine botulique

Chronic migraines: Find out how botulinum toxin can be effective

Oct 09, 2023

“Wrinkle reducer” treatments that use botulinum toxin can also be used to treat chronic migraines . These treatments, known as neuromodulatory drugs (such as Botox, Dysport, Xeomin, and Mybloc), were approved by the U.S. Food and Drug Administration in 2010 for the treatment of migraines.

What is botulinum toxin and how does it work?

Used for centuries for medical purposes, botulinum toxin , commonly known as botox, is a substance produced by a bacteria called Clostridium botulinum. Although the toxin is associated with a potentially fatal condition called botulism, when used correctly and in appropriate doses, it can have impressive therapeutic effects.

The way botulinum toxin works is based on its potential to inhibit the release of specific chemicals in the body , particularly acetylcholine, a neurotransmitter that triggers muscle contraction. When botulinum toxin is injected in small amounts into a specific muscle, that muscle becomes paralyzed or weakened, resulting in a temporary reduction in excessive muscle activity.

Its inhibitory effects are not limited to muscles, but also extend to specific nerve structures , resulting in the blocking of pain signals that are routed to the brain. For this reason, botulinum toxin is also used in the treatment of various painful conditions, including migraines.

It is important to note that the action of botulinum toxin is temporary , meaning that the therapeutic effects gradually disappear over time . This is why periodic injections are necessary to maintain the benefits of the treatment.

A powerful treatment option

Plastic and reconstructive surgeon Sashank Reddy explains how these medications are a powerful treatment option for patients suffering from chronic migraines.


  • The injectables used to treat migraines are the same ones used by cosmetic surgeons and dermatologists to minimize facial wrinkles.
  • Licensed medical professionals treat migraines by injecting botulinum toxin into several areas around the head and neck.
  • Treatments are approved for certain people aged 18 and older who experience 15 or more days of migraines per month. We then speak of chronic migraine.
  • It may take four weeks or more after treatment before you notice a reduction in the frequency of your migraines, and several rounds of injections may be necessary.

How does botulinum toxin help treat migraines?

Researchers are eager to understand how botulinum toxin medications relieve migraine pain . Evidence suggests that the drug interrupts the pain transmission path between the brain (central nervous system) and the nerves that extend from the spinal cord.

When you have a migraine, your body releases substances called neurotransmitters and molecules associated with pain . Botulinum toxin interferes with the transmission of these substances, usually where nerves and muscles meet. Researchers believe that when the drug is injected into the muscles around the face, head and neck, it is absorbed by nerves and interferes with neurotransmission associated with pain.

botulinum toxin and how does it work?

Why might I need botox injections to treat migraines?

Botulinum toxin treatments have proven effective in clinical trials and are a way to treat chronic migraines . Other medications and lifestyle changes may be recommended. If your doctor determines that you suffer from chronic migraines, you may be a candidate for this treatment.

Sashank Reddy says, “Botulinum toxin injectables are part of a comprehensive range of options that neurologists and headache specialists have for the treatment of chronic migraines. Although no option is ideal in all cases, a combination approach to multiple treatments can often reduce the frequency and severity of headaches. »

Migraine Botox Treatment – ​​What to Expect

Using a very small needle , a specialist injects botulinum toxin into the tiny muscles under your skin in different areas around your face, head and neck .

You may receive injections on your forehead, temples, and the back of your head and neck. Sometimes the specialist will inject areas called “trigger points” where migraine pain begins.

“These treatments for chronic migraines need to be individualized, respecting each patient's unique anatomy and pain points of origin,” Reddy says.

It may take several weeks and several treatments before you start to feel relief from your migraines . Some patients find they can stop the injections without frequent migraines returning. Others need regular treatments to control their migraines.

“Injectables may be effective in reducing headache frequency in patients with chronic migraines and may also reduce the disabling symptoms associated with these migraines,” says Reddy.

What are the risks of using injectables for migraines?

Botulinum toxin injectables should be avoided by pregnant women and nursing mothers , as well as people allergic to cow's milk proteins.

When administered by a qualified specialist, botulinum toxin injections are relatively safe. However, some people experience pain, bruising, or swelling where the medicine was injected.

Other possible side effects are:

  • Headache or flu-like symptoms
  • Dry or watery eyes
  • Drooping of an eyelid, eyebrow or side of the mouth
  • Excessive salivation

Very rarely, if the toxin accidentally spreads through your body, other, more serious symptoms may appear over the next few hours or days. Call your doctor immediately if you notice:

  • Vision problems
  • Muscle weakness
  • Difficulty speaking or swallowing
  • An inability to control the bladder
  • Difficulty breathing.

Clinical results and studies on the effectiveness of botulinum toxin for migraines

Clinical research has contributed greatly to our understanding of the effectiveness of botulinum toxin as a treatment for migraines. Indeed, several large-scale studies have highlighted that this substance, although usually associated with cosmetic treatments, can offer significant relief to people suffering from severe and chronic migraines.

In 2010, the European Medicines Agency authorized the use of botulinum toxin for the treatment of chronic migraine after reviewing a series of clinical trials. Among the most significant is the PREEMPT study, a randomized, double-blind phase 3 clinical trial. This study demonstrated that patients receiving botulinum toxin injections had a significant reduction in the number of migraine days per month compared to those receiving placebo.

At the start of the study, patients had an average of 20 headache days per month, which was reduced by almost half after two cycles of botulinum toxin treatment.

In addition to the PREEMPT study, other research has highlighted the effectiveness of botulinum toxin for migraines. A meta-analysis of 17 clinical trials found that patients treated with botulinum toxin had a significant reduction in migraine frequency compared to patients receiving a placebo.

New perspectives

However, the research is not over; Researchers continue to study the specific mechanisms by which botulinum toxin works to prevent migraines . Additionally, additional studies are needed to evaluate the long-term effectiveness of this treatment and to identify patients for whom this treatment is most effective.

In sum, the current results are promising and indicate that botulinum toxin may be a viable treatment option for people suffering from severe and chronic migraines. This is encouraging news for the millions of people for whom migraines are a daily reality.

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