Chronic Migraine: Botox Does Not Work Better Than Withdrawal from Pain Medication

Patients with chronic migraine who use a lot of pain medication can better stop this than undergo botox treatment. Headache researchers from the Leiden University Medical Center conclude this from a large-scale randomized controlled clinical study. They published the results in the magazine Brain.

chronic migraine

Paradoxically, excessive use of painkillers and anti-migraine medication can lead to an increase in seizures and chronic migraine . In North America in particular, patients with chronic migraine are treated with botox injections at 31 places in the head. However, there is moderate scientific evidence for this treatment. In the Netherlands and other European countries, it is advised to withdraw from all pain medication. 

Acute medication immediately

Researchers from the Leiden headache group led by neurologist Gisela Terwindt are now showing for the first time that botox treatment does not work better than stopping all pain medication. They did this by having 179 patients with chronic migraine who used excessive pain medication stop all pain medication acutely for 12 weeks. In addition, half received botox treatment and the other half injections with saline. To prevent it from noticing who had received botox, the placebo group also received injections with a very small amount of botox. This was enough to reduce forehead wrinkles – just like in the treatment group – but not enough to be effective against the migraine.

Botox does not add anything

Stopping pain medication worked well: after withdrawal, the number of headache days decreased by 25% (5 days), and the number of migraine days by 45% (6-7 days). Botox did not add anything to this effect. There was, up to a year after treatment, no difference between the group that did and did not receive botox. Sixty percent of the patients no longer suffered from chronic migraine and more than thirty percent no longer needed preventative medication. The majority of patients would recommend stopping pain medication to fellow patients.

“Our results show that withdrawal from pain medication and not botox should be the first treatment option in patients with chronic migraine and excessive use of medication. It is well tolerated, effective and considerably cheaper than botox, “says Terwindt.