• Proven efficacy: Strong clinical evidence 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 effects compared to oral preventive medications

• Convenient dosing: Requires treatment only four times per year

• Quality of life improvements: Significant 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

• 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

Common Side Effects

Most side effects are mild and temporary:

• Neck pain or stiffness (most common)

• Headache (may occur initially before improvement)

• Muscle weakness in the neck or shoulders

• 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.

The NHS recognises Botox as an evidence-based treatment 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 assessment and treatment.

While the NHS recognises Botox as evidence-based for chronic migraine, access can be limited by strict eligibility criteria, regional variations, and lengthy waiting 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.

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 patients maintain improvement with continued treatment over several years

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

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

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

3. Injection Sites: Botox is injected at multiple sites across the head and neck, following a standardised 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.

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

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

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 multi-site approach targets the nerves and muscles most commonly involved in migraine attacks.

• 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 adequately to other preventive treatments: Has tried at least 2-3 oral preventive medications without sufficient benefit

  • Experiences significant disability: Migraine substantially impacts 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

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 regulatory authorities underscores the robust clinical evidence supporting Botox as a legitimate therapeutic option for chronic migraine sufferers.

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

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 medications that may interact with Botox