Botox

Botox works to gradually decrease the frequency and severity of migraine headaches, and for many people it’s an effective treatment that improves their quality of life.

The use of Botox for chronic migraine has been increasing since it was first listed on the Pharmaceutical Benefits Scheme (PBS) in 2014. In a study published in the Journal of Neurology, Neurosurgery & Psychiatry of 211 patients using PBS-subsidised Botox for chronic migraine, 74% obtained 50% or greater reduction in headache days per month (from a mean of 25 to 11 days). Acute medication intake reduced from a mean of 19 to 7 days per month and the proportion of patients using opioids also decreased significantly, with over-the-counter codeine dropping from 44% to 28% and prescription opioids from 23% to 13%.

It is important to note that Botox is a headache prevention treatment, not a migraine attack prevention treatment. If you do not experience significant headache or if headache is not your most bothersome symptom, you are unlikely to experience good results from Botox. 

Botox requires seeing a neurologist every three months while treatment is administered. Your neurologist uses a small needle to inject 0.1ml or 5 units of Botox at 30 or more sites all over your head. You may feel a slight sting with each injection. 

The treatment takes about 15–20 minutes and there aren’t any restrictions on driving or other daily activities after treatment.

It can take up to 6 months for any benefit to be seen, and many people report that the benefits of Botox start to wear off after about 10 weeks, and the intensity and frequency of their migraine attacks increase close to their next treatment date.

Botox can be used in combination with the new CGRPs or other older medications. (Note that both Botox and a CGRP cannot be provided concurrently under the PBS, one must be as a private prescription)

Botox on the PBS 

Botox is approved only for chronic migraine and there’s no evidence to support its use to help treat episodic migraine or other types of headache.

Botox for chronic migraine is accessible on the pharmaceutical benefits scheme (PBS) from a neurologist trained in Botox use. To qualify, you must meet all of the following criteria:

• An average of 15 or more headache days a month, with at least 8 days of migraine, for at least 6 months before starting treatment.
• Had an inadequate response, intolerance or contraindication to at least 3 prophylactic migraine medications (propranolol, amitriptyline, methysergide, pizotifen, cyproheptadine or topiramate).
• Be managed for medication overuse headache.
• Be aged 18 and over and treated by a neurologist.

To continue to receive Botox on the PBS you must achieve and maintain a 50% or greater reduction from baseline in the number of headache days per month after 2 treatments, 12 weeks apart.

Things to be aware of

Botox treatment is expensive if you do not qualify for PBS coverage. When covered by the PBS, the government pays the majority of the cost. The amount you pay per treatment can vary significantly and may be up to a few hundred dollars when including consultation fees.

We are aware of some neurologists charging very high fees over $500 - doctors can charge what they like, but you don't have to pay it. Feel free to call around and find someone charging something a bit more reasonable.

Not all neurologists administer Botox, so you may need to go to a different neurologist than your normal specialist. Similarly, while it is possible to get Botox through a public neurology clinic, it will depend entirely on the availability of a trained specialist, and the wait times may be very long. 

Some neurologists are also a bit pushy when it comes to Botox, offering it to new patients without discussing the options, and insisting they continue with the protocol even if it isn't working or if patients experience significant side effects. We are also aware that some neurologists tell patients that Botox has no side effects - it does.

The general side effects of Botox are pain, tenderness, inflammation, tingling or numbness, swelling, dry mouth, redness of the skin, infection, bleeding and/or bruising at the site of injection; generally feeling unwell and weakness.

The additional side effects that are noted for the chronic migraine protocol are: loss of movement on the face, drooping of the eyelids, skin rash, itching, pain at the injection site, neck pain, muscle pain, tenderness or weakness, muscle spasms or tightness. Less commonly: pain of skin, pain of jaw and difficulty in swallowing. Headache, including worsening migraine, has been also reported, usually occurring within the first month.

The following symptoms have been reported on rare occasions: changes in the way the heart beats, chest pain, skin rash and allergic reaction (symptoms: shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue or other parts of the body; rash, itching or hives on the skin). In some cases, the effect of botulinum toxin may be observed beyond the site of injection and the following symptoms may occur: loss of strength and muscle weakness, drooping of the upper eyelid, double or blurred vision, trouble speaking or saying words clearly, constipation, aspiration pneumonia (serious lung infection), and trouble swallowing or breathing, which can be life-threatening. These symptoms can happen hours to weeks after injection and are more likely to occur in patients treated with high doses or who have underlying conditions that would predispose them to these symptoms. If experience any of these more severe side effects please go to Emergency and tell your doctors. 

Read the patient information sheet before considering this treatment and discuss it with your doctors.