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Migraines Treatment

What is Chronic Migraine?

Chronic migraine is defined as experiencing headaches on 15 or more days per month, with at least 8 days having migraine features, for more than 3 months. This condition significantly impacts quality of life, work productivity, and daily functioning.

The Science Behind Botox for Migraine

Botox works by blocking the release of certain neurotransmitters involved in pain transmission. Specifically, it:

Inhibits the release of pain-related and neurotransmitters (such as substance P, CGRP, and glutamate)

Prevents sensitisation of pain nerve endings

Reduces the activation of central pain pathways

Relaxes muscles that may contribute to tension-type headache components

Prices

Treatment

£800

Further Treatment

£300

The standardised injection technique for Botox in chronic migraine treatment is based on the PREEMPT (Phase III Research Evaluating Therapy) clinical trials. This protocol established the specific injection sites, dosing, and administration technique that in treating chronic migraine.

Fixed-site, fixed-dose approach: The protocol 31 mandatory injection sites across 7 key head and neck muscle areas, with a total of 155 units of Botox

Follow-the-pain strategy: Up to 40 additional units may be administered in areas where patients experience the most pain, allowing for individualised treatment

Bilateral injections: Injections are administered symmetrically on both sides of the head and neck

Shallow intramuscular technique: Precise injection depth and angle to target specific muscle groups

Evidence-based effectiveness: This approach was validated through large-scale clinical trials showing significant reduction in headache days

The PREEMPT protocol targets these muscle groups:

Frontalis: Forehead muscles (10 units divided between both sides)

Corrugator: Muscles between the eyebrows (10 units divided between both sides)

Procerus: Bridge of the nose (5 units)

Occipitalis: Back of the head (30 units divided between both sides)

Temporalis: Temple area (40 units divided between both sides)

Trapezius: Upper back/shoulder muscles (30 units divided between both sides)

Cervical paraspinal: Neck muscles (20 units divided between both sides)

This systematic approach ensures treatment delivery and replicates the conditions under which Botox was proven effective in clinical trials.

FAQs

Benefits of Botox for Chronic Migraine

Proven efficacy: Strong supporting its effectiveness in reducing migraine frequency and severity

Reduced medication burden: May decrease the need for acute migraine medications and reduce the risk of medication overuse headache

Favourable safety profile: Generally well-tolerated with minimal systemic side compared to oral preventive medications

Convenient dosing: Requires treatment only four times per year

Quality of life improvements: improvements in disability, work productivity, and overall well-being

Non-systemic treatment: Works locally without requiring daily oral medication

No drug interactions: Does not interact with most other medications

Limitations for Botox for Chronic Migraine

Time to effect: May take 2-3 treatment cycles (6-9 months) to achieve optimal results

Ongoing commitment: Requires regular appointments every 12 weeks

Not effective for everyone: Approximately 60-70% of patients respond to treatment

Temporary effects: Benefits wear off over time, requiring continued treatment

Potential Side Effects from the Migraine Treatment

Common Side Effects

Most side effects are mild and temporary:

Neck pain or stiffness (most common)

Headache (may occur before improvement)

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Drooping eyelid (ptosis) - rare and temporary

Injection site pain, bruising, or swelling

Flu-like symptoms

Rare but Serious Side Effects

Though uncommon, patients should be aware of:

Difficulty swallowing or breathing

Speech problems

Severe muscle weakness

Allergic reactions

Patients should contact us immediately if they experience any concerning symptoms.

NHS Perspective on Botox for Chronic Migraine

The NHS recognises Botox as an evidence-based for chronic migraine, supported by NICE guidance (TA260) from 2012. Access is restricted to patients who meet specific criteria: confirmed chronic migraine diagnosis (15+ headache days per month), failure of at least three oral preventive medications, resolution of any medication overuse, and specialist referral. Treatment is provided free when approved, typically with a 6-month trial period. However, availability varies significantly by region and CCG, with potential waiting times for and treatment.

While the NHS recognises Botox as for chronic migraine, access can be limited by strict eligibility criteria, regional variations, and lengthy times. At Karwal Aesthetics, we are a private healthcare provider and do not work with the NHS. We offer migraine treatments at out London, Mayfair clinic.

Migraine Treatment Rates and Expectations

Clinical data shows:

Response rate: Approximately 60-70% of patients experience a meaningful reduction in headache days

Average reduction: 8-9 fewer headache days per month

Improvement timeline: Gradual improvement over the first 2-3 treatment cycles

Sustained benefits: Many maintain with continued treatment over several years

Acute medication use: reductions in the need for pain-relieving medications

How is the Treatment ?

Consultation: A thorough assessment is performed to confirm the diagnosis of chronic migraine and to rule out other causes of headache.

Preparation: The skin is cleansed. No anaesthetic is usually required as the injections are quick and use a very fine needle.

Injection Sites: Botox is injected at multiple sites across the head and neck, following a protocol known as the PREEMPT (Phase III Research Evaluating Migraine Prophylaxis Therapy) protocol.

Typical areas include the forehead, temples, back of the head (occipital region), neck, and shoulders.

In total, around 31–39 injections are given in one session.

Procedure Time: The treatment takes about 15–20 minutes.

Aftercare: Patients can return to normal activities immediately, though it’s best to avoid strenuous exercise for 24 hours.

Where is Botox Injected for Migraines?

Botox is injected into seven key muscle areas around the head and neck, including:

Forehead (frontalis muscle)

Temples (temporalis muscle)

Back of the head (occipitalis muscle)

Neck (cervical paraspinal and trapezius muscles)

Above the ears (temporalis)

Bridge of the nose (procerus)

Upper shoulders (trapezius)

This approach targets the nerves and muscles most commonly involved in migraine attacks.

Who Should Consider Botox for Migraines?

The ideal candidate for Botox migraine treatment typically:

Has chronic migraine: Experiences headaches on 15 or more days per month, with at least 8 days having migraine features

Has not responded to other preventive treatments: Has tried at least 2-3 oral preventive medications without sufficient benefit

Experiences significant disability: Migraine substantially work, school, or daily activities

Is 18 years or older: Botox for chronic migraine is approved for adult patients

Can commit to regular treatment: Willing to attend appointments every 12 weeks

Has realistic expectations: Understands that results may take several months to manifest

Approval and Clinical Recognition

Botulinum toxin type A, commonly known as Botox, has emerged as an effective preventive treatment for chronic migraine. Initially approved by the FDA in 2010 for this indication, Botox represents a significant advancement in migraine management for patients who experience frequent and debilitating headaches.

The NHS recognises Botox as an evidence-based treatment for chronic migraine, supported by NICE guidance (TA260) from 2012. This dual recognition from both American and British authorities underscores the robust clinical evidence Botox as a legitimate therapeutic option for chronic migraine sufferers.

Where we offer migraine treatments?

Migraine treatments are performed at our Mayfair Clinic, 15 Dover Street, W1s 4LP.

Who May Not Be Suitable for this Treatment

Botox may not be appropriate for individuals who:

Have episodic migraine (fewer than 15 headache days per month)

Are pregnant, planning to become pregnant, or breastfeeding

Have certain neuromuscular disorders (such as myasthenia gravis or Lambert-Eaton syndrome)

Have allergies to botulinum toxin or any ingredients in the formulation

Have an infection at the proposed injection sites

Are taking certain that may interact with Botox

Business Enquiries

Mayfair, London
2nd Floor, 15 Dover Street, W1S 4LP

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0% finance is available on all treatments from £500. Find out more by visiting our Payment Plan page.

Please note: our clinic is on the second floor with stair access only.

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