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Effectiveness of Botox® Questioned

Though Botox® (botulinum toxin type A) was recently approved to treat chronic migraine in both the US and the UK, the actual effectiveness of the injections still seems to be in question. An article in Drug and Therapeutic Bulletin, which is affiliated with BMJ, contends that the evidence is limited and “unconvincing.”

The article raised four issues. First, the author contends that the actual benefit of Botox, in terms of reduced headache days, was small as seen in studies. Second, these studies included some patients with medication overuse headache, which could mean their symptoms and/or responses were attributable to other drugs they were taking for headache. Third, Botox treatment is expensive and, lastly, Botox’s side effects include headaches as well as rash, pain, stiffness and muscle spasm.

Other headache specialists have noted that responses to Botox are quite variable, with some patients having a marked reduction in headache days and others experiencing no change at all. “Many physicians have used Botox for years and have found it to be effective, safe, cost saving, and a satisfactory treatment for many chronic migraineurs,” said Arthur Elkind, MD, president of the National Headache Foundation. The UK’s drug regulatory agency noted in its approval that Botox avoided the systemic side effects of pills and had a better safety profile.

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