Botox was approved by the FDA for chronic migraine treatment in 2010.  Recent analysis of 17 previous randomized trials comparing botulinum toxin with placebo for preventive treatment of migraine headaches revealed that Botox was effective at reducing migraine severity and number of episodes per month. The 17 studies included nearly 3,650 patients, about 1,550 of whom had chronic migraine: defined as at least 15 headache attacks per month for more than three months, with migraine symptoms on at least eight days per month. The remaining patients had less-frequent episodic migraine headaches.

On data analysis, botulinum toxin injections significantly reduced the frequency of chronic migraine attacks. Three months after injection, patients treated with botulinum toxin had an average of 2 fewer migraines per month, compared to those treated with placebo.  The improvement was apparent within two months of botulinum toxin treatment.

Migraine headaches are an increasingly common condition, leading to significant disability and increased use of healthcare resources.  Depression can also result from migraine symptoms and can worsen the outlook for the patient.  Although botulinum toxin injection for chronic migraine is FDA-approved, it has not achieved universal approval among all practitioners who treat migraine headaches.

The results of the pooled data strongly support the effectiveness of botulinum toxin injection as preventive treatment for chronic migraine, with significant reductions in headache frequency.  Botox has also been used reduce tension headaches, though many suggest the data is poor or that the data suggests that Botox is ineffective for tension headaches.  Some treating physicians that Botox effectiveness in treating tension headaches may stem from misdiagnosis of migraine headache as tension headache.

Dr. Kenneth Hughes has used Botox in his practice to treat chronic migraines and has has similar success in patient symptoms.

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