Campaigners welcomed the move, which will see patients receive injections of the muscle- paralysing toxin on their face, head and neck every 12 weeks to prevent the onset of migraines and reduce pain.
It is thought that about 3,764 people in Scotland will be eligible for the treatment annually, at a cost of £1,380 per patient.
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However, the Scottish Medicines Consortium (SMC) expects the actual uptake will be about 83 patients in the first year, rising to 232 patients and a cost of £278,000 after five years.
Additional costs for specialist nurses to administer the injections are estimated at £119,000 in the first year rising to £335,000.
The decision to approve Botox for migraine treatment brings Scotland into line with the rest of the UK, and comes after two previous rejections by the SMC. Migraine patients in England and Wales have had access to the treatment since 2012.
Dr Alok Tyagi, a consultant neurologist at the Queen Elizabeth University Hospital in Glasgow, said: “The routine availability of this treatment will lead to a significantly improved quality of life for patients reducing their unnecessary suffering, use of NHS resources and days missed from work.”
Migraine sufferer Elaine Bell, 50, has been plagued with the condition all her life but found a breakthrough when she began funding Botox privately in January 2015.
She said: “After decades of missed family events, opportunities, work, education and social functions I am finally experiencing an overall improvement in the quality of my life and that of my family.”
Chronic migraines are defined as having at least 15 headaches per month lasting four or more hours, at least eight of which are migraine attacks. As well as intense throbbing pain, symptoms can include visual distortions such as zigzag or flashing patterns, nausea, vomiting or increased sensitivity to bright light, noise or smell.
While Botox is still better known as a cosmetic “wrinkle-freezing” treatment popularised by celebrities, doctors are increasingly discovering alternative uses for it – including a potential therapy for depression, abnormal heartbeat and severe neck spasms.
It is unclear why it appears to counteract migraine, but it has been suggested Botox may reduce blood pressure in the brain by relaxing muscles around the head or reduce the nerves’ ability to send pain signals during a migraine.
Hannah Verghese, advocacy, policy and campaigns manager at The Migraine Trust, said: “Increasing the number of treatment options for people with this highly debilitating and disabling condition offers the prospect of reduced pain, reduced social isolation and a greater quality of life.”
SMC chairman Professor Jonathan Fox said: “For those suffering with chronic migraine for which other treatments have not been effective, botulinum toxin type A (Botox) fulfils an unmet need.”