You’ve probably seen celebrities getting BOTOX^(R) to maintain youthful looks. A few may even look as if they’ve overdone it. But did you know BOTOX works for some migraines, too?

As of 2010, the FDA approved BOTOX as a treatment for adults with chronic migraines. It isn't suitable for everyone, but it may be something to discuss with your healthcare provider.

What Is BOTOX?

BOTOX is a trademarked name for a highly purified and diluted medication made from the Botulinum Toxin A, a neurotoxin produced by Clostridium botulinum. 

When diluted and given in tiny doses to specific areas of the head and neck, this neurotoxin is used to reduce muscle contractions and movement that can lead to wrinkles or migraines.

BOTOX has only been cleared for use in the 3% of migraineurs diagnosed with chronic migraine. People with chronic migraine suffer 15 or more headache days a month. The more frequent the head pain, the better the patient seems to respond. 

It is not recommended for anyone with fewer headache days or who suffers from episodic migraine. While it isn’t meant for use in children or adolescents, some providers use it “off label” (outside of FDA approval) for younger patients.

How Does BOTOX Work?

A trained healthcare provider injects small amounts of BOTOX beneath the skin around the pain fibers involved in headaches. The neurotoxin enters the nerve endings around the injection site and blocks the release of chemicals that communicate pain transmission. It prevents the activation of the pain networks in the brain.

To get into the scientific weeds, Botulinum Toxin A disrupts the function of neuromuscular junctions by blocking the release of the neurotransmitter acetylcholine. However, researchers are still not certain about the mechanism for BOTOX effects.

According to Dr. Andrew Blumenthal, maximum effects may not be seen until the second or third treatment. Patients see increasing benefits with an increase in the number of treatment cycles. Many patients reported that it took at least two treatments (up to six months) to reduce the number of headache days by half. 

Fortunately, you can take other over-the-counter and prescription migraine medications while waiting for the BOTOX to work.

Studies Show BOTOX’s Effectiveness

A two-phase study performed before FDA approval of BOTOX for migraines studied patients who averaged 20 headache days a month. Each received BOTOX injections every 12 weeks for 56 weeks. At the end of the study, 70% reported less than half the number of headaches compared to before treatment.

Up to 90% of Migraine Relief Center patients using BOTOX report their migraines are less frequent and severe, and respondents in clinical trials reported seven to nine fewer headache days per month.

A standard course of treatment found that 81% of respondents reported less frequent and/or less intense head pain in one study. Over 60% reported excellent pain relief, while 20% reported some pain relief.

Where Does BOTOX Fit into a Treatment Regimen?

BOTOX alone is not sufficient for the effective treatment of chronic migraines. You and your doctor should develop a comprehensive migraine management plan that includes a healthy lifestyle that avoids triggers whenever possible. Also, the plan includes OTC and prescription abortives as needed. 

The BOTOX Treatment Process

Before selecting a provider to give you the treatments, ask a few questions. Where did the provider learn to give BOTOX? How many times have they given BOTOX, and how many injections do they plan to give you? Where will the injections be given?

You want to know how much experience this individual has with BOTOX and treating migraines. 

The doctor you choose looks at your symptoms and history. You should list all your medications, how they have performed, and whether you have used BOTOX in the past. Once the physician determines BOTOX to be an appropriate treatment, the office sets you up for an injection series. Each appointment lasts about 20 minutes. 

To inject BOTOX, the providers use a very small needle, which most describe as feeling like a pinprick, to inject BOTOX into the predetermined areas, which can include:

• The forehead
• Both temples
• Back and sides of the neck
• The upper shoulders
• The back of the head

Before beginning treatment, you and your physician identify where you experience head pain and which muscle groups seem to be involved. Sometimes the doctor uses ultrasound to determine the best injection location.

Each treatment consists of up to 32 injections in seven key areas of the head and neck. Individual patients may not require so many since each patient is different. Small amounts of BOTOX are injected and begin to work immediately. You may experience complete results within a week. 

Most patients receive five rounds of injections over 15 months. Depending on the patient, the effects can last from weeks to months. If surgical intervention is under consideration, mapping the effects of BOTOX injections can help the doctor target the correct areas for surgery.

Common Side Effects and Risks

The most common side effect is a sore neck, and an ice pack placed over the injection site can relieve some of the pain. Other side effects include bruising and discoloration, skin lumpiness, flu-like symptoms, or headache.

More serious side effects include problems swallowing, speaking or breathing, especially if these were problems before BOTOX is administered. Another risk is that the BOTOX will spread and result in issues away from the injection site, like:

• Loss of strength and overall muscle weakness
• Double or blurred vision, droopy eyelids
• Hoarseness or loss of voice, trouble saying words clearly
• Loss of bladder control
• Drooling 

Talk to the provider about the risks and how to mitigate them.

Cost and Insurance

The FDA recommends a dosage of 155 units. Treatment prices range from $200 to thousands of dollars. However, because BOTOX is FDA-approved for migraine treatment, Medicare, Medicaid, and most insurance companies cover it. Also, Allergan, the manufacturer of BOTOX, offers a savings card to reduce fees. 

That being said, many insurance plans will not approve BOTOX until you have tried and failed to respond to at least two other preventative treatments for chronic migraines, like anti-seizure medications, antidepressants, or blood pressure drugs. More on Migraine Relief Center insurance coverage here.

Where to Get BOTOX

Many headache specialists, including those at the Migraine Relief Center, offer BOTOX as part of treatment for chronic migraines. Check your insurance database for a list of providers in neurology or look at the American Migraine Foundation’s doctor database. 

If you suffer from chronic migraine, contact our specialists today. We can help you decide whether BOTOX will work for you.