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The Truth About Getting Botox to Help With Migraines

·4-min read
Photo credit: Getty Images
Photo credit: Getty Images

If you suffer from chronic migraines, you know what intense pain feels like — and there's no doubt you want an effective treatment to ease the awful ouch, as well as to avoid missing out on both work days and fun times.

You may have heard that Botox, or its drug name, OnabotulinumtoxinA, can be used to treat chronic migraine through preventing these intense head-bangers. Data from Botox's parent company states that the drug is the number one prescribed chronic migraine treatment, and has been used over 4.2 million times on over 600,000 patients for over a decade. And research has shown that the drug is effective in reducing the number of chronic migraines in patients, as well as the severity of the pain.

If you're thinking of giving Botox a try for your migraines, here, a top headache expert answers your questions about this treatment.

First, what are chronic migraines?

According to the Mayo Clinic, you fit the diagnostic criteria of chronic migraine if:

  • You have headaches 15 or more days per month, for a minimum of three months

  • Your pain is on one or both sides of your head, is throbbing, and moderate to severe in nature

  • You experience either nausea and/or vomiting, plus a sensitivity to light and sound, or both of those unpleasant symptoms

What is Botox?

Data from Harvard Medical School says that botulinum toxin type A (from which Botox is made) is a protein that comes from a form of bacteria called Clostridium botulinum. Botulinum is a neurotoxin, which means it paralyzes muscles in your body by targeting your nerve cells. If you eat food contaminated with it, you can get the dangerous illness botulism, but if you have a purified form of it injected into your skin in extremely low doses, it can be a beneficial treatment to soften the look of wrinkles are so popular and effective.

How does Botox work to prevent and/or treat migraine?

“Botox is injected around pain fibers that are involved in headache,” says Lauren R. Natbony, MD, assistant clinical professor of neurology, headache and facial pain at Icahn School of Medicine at Mount Sinai in New York City, and associate director of North Shore Headache and Spine. “It works by diffusing down to pain terminals and stopping the release of overactive pain signals. This in turn prevents the activation of pain centers in the brain.”

What can you expect during a Botox migraine treatment?

“Treatment is pretty quick and takes about 15 minutes,” Dr. Natbony explains. “Your doctor uses a very small needle to inject Botox into 31 injection sites over your forehead, temples and the back of your head, neck and shoulders. Injections feel like little pinpricks, and there may be a brief burning sensation at the injection sites. Overall, the process is not especially painful. Most patients are able to return to their routine daily activities immediately.”

Photo credit: PeopleImages - Getty Images
Photo credit: PeopleImages - Getty Images

What side effects are linked to Botox for migraine?

“Always discuss potential side effects with your doctor,” says Dr. Natbony. “Overall, Botox is safe and extremely well tolerated with a low risk of side effects. The most common side effect is soreness at the injection site, which can be relieved with ice or an anti-inflammatory drug. Some patients may experience neck pain and stiffness, which usually resolves within days to weeks. Eyelid and eyebrow asymmetry and droop can happen but are rare. These cosmetic effects self-resolve as Botox wears off.”

How do you know if Botox is right for your migraine issue?

To qualify for Botox treatment from an insurance perspective, it’s important to know that most companies will require that you try at least two daily oral preventative migraine medications first. “Botox, like any treatment for migraine, is not a cure, but can significantly reduce migraine frequency and severity,” says Dr. Natbony. “It’s important to have a frank discussion with your doctor about goals of care. What we aim for is at least a 50% reduction in migraine frequency and severity. So if someone is having 20 days of migraine headache per month, our goal is to get them down to 10 days or less with Botox. It can take time for Botox to start working, up to 9 months or 3 treatment cycles. However, most patients see some degree of improvement after the first or second treatment.”

What are your options if Botox isn’t right for you?

“There is now another class of medication that’s FDA-approved for the preventative treatment of chronic migraine — CGRP Monoclonal Antibodies,” says Dr. Natbony. “It includes the monthly injectables Aimovig, Emgality and Ajovy, and a quarterly IV infusion (Vyepti).”

You can also try alternative therapies such as acupuncture, biofeedback and meditation.

The bottom line: Everyone is different, so working with your doctor to find the best treatment or combination of treatments is essential. Here’s to more migraine-free days!

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