Editor’s note: The quotes are from original interviews with the sources.
Imagine this scenario: You wake up one Monday morning with a busy day ahead of you. You feel like it’s going to be a good day and then – bam! – it hits you: an excruciating migraine.
You’re very familiar with the pain – since it happens so often – but medications and other treatments prescribed by your doctor aren’t helping.
Are you doomed to have migraines for the rest of your life? Not necessarily: doctors now use Botulinum toxin type A, known commercially as Botox, as a treatment for chronic migraine pain.
“Botox has emerged as an important treatment option for patients plagued with migraines, providing longer-lasting results than oral treatments without resorting to invasive surgical procedures,” says Melissa Doft, MD, a board certified plastic surgeon in New York, N.Y.
Why Botox Works on Migraines
The FDA approved Botox as a migraine treatment in 2010.
“Though the mechanism is not fully understood, Botox is thought to prevent certain chemicals from reaching nerve endings, thereby reducing migraine pain,” says Tim Neavin, a board certified plastic surgeon in Beverly Hills, Calif.
Botox interrupts neuropathways in pain to treat chronic migraines. This is achieved with the injection of Botox into muscles of the forehead, the side and back of the head, and the neck and shoulders to produce a partial and temporary chemical ‘denervation’ of the muscle.
“Injections of this neurotoxin produce weakness of the muscles, inhibiting their ability to maximally contract, and ultimately treat pain associated with migraine headaches related to this muscle activity,” says Dr. Neavin.
“Fortunately, the dosage used to treat chronic migraine headache pain is very low since the muscles related to the condition are small.”
Who Can Benefit from Botox for Migraines
Botox is recommended for adult patients who suffer from chronic severe headaches for more than 15 days a month and have difficulty tolerating preventive medications, according to Dr. Doft.
“In a study by Silberstein, patients who were treated with 25 units of Botox experienced fewer migraine attacks per month, less severe migraines, fewer days when they needed acute migraine medication and less migraine-associated vomiting,” says Dr. Doft.
Some studies indicate that up to 70 percent of people with migraine headaches will have a substantial reduction of symptoms of their migraine related head pain after Botox injections.
However, Botox doesn’t work on all types of headaches.
“Tension headaches are far more common than migraine headaches and there is little data to suggest that Botox works well for these more common pattern headaches,” says Dr. Neavin.
Side Effects of Botox for Migraines
Despite the toxicity of Botulism neurotoxin, Botox is incredibly safe, according to Dr. Neavin.
“The dosage used is far, far below the levels necessary for serious side effects seen in the fatal illness of botulism,” he says.
The most common side effects associated with Botox injections include bruising and slight discomfort or pain at injections sites. In rare cases, injections too close to the eye can cause a temporary droopy eyelid.
Larger doses of Botox in the forehead can cause paralysis of the forehead muscles that may effect animation of brows, or create a (correctable) asymmetry of brow movement.
“For these reasons, I strongly recommend that injections be performed by a physician experienced with Botox injections in treating migraines or wrinkles to reduce unwanted side effects,” Dr. Neavin says.
Botox for Migraines Treatment Plan
The FDA-recommended treatment is for 31 injections in sites around the head, according to Dr. Doft.
“The procedure takes 10 minutes to perform and the neurotoxin takes 5-10 days to start to work,” advises Dr. Doft.
Once the neurotoxin is at work, effects can last up to 3 months or more, adds Dr. Neavin.
Even if Botox therapy does not prevent or eliminate all migraine headache pain, it may reduce need for medication dosage and frequency.