The Drug and Therapeutics Bulletin (DTB) has featured a review of the safety and efficacy of the use of botulinum toxin A (Botox) for the prevention of headaches in adults with chronic migraine. This treatment involves 12-weekly injections into
31 to 39 sites in the head and neck muscles.

The review concludes that “Most patients in the main published trials of botulinum toxin A overused acute headache treatments, a feature which precludes the diagnosis of chronic migraine according to the current definition of this condition and the standard management for which includes withdrawal of the overused medication. These discrepancies and the limited evidence of benefit make it difficult for us to see a place for botulinum toxin A as treatment for chronic migraine.”