Here’s what you need to know about using Botox to treat migraines and how to tell if it’s right for you.
What is botox?
Since its creation in the late 1980s, Botox has become a popular way to treat everything from wrinkles to chronic migraines. It works by injecting a toxin known as botulinum into the skin.
“[Botulinum] temporarily inhibits the nerve cells that are responsible for sending specific signals to muscles, causing them to contract,” says Michele Green, MD, a cosmetic dermatologist in New York. “Botox works by ‘freezing’ the nerve terminals, which can produce pain, and also relaxes the muscle.”
Worldwide, about 30% of people ages 18 to 65 experience migraines each year, with between 1.7% and 4% of adults having chronic migraines.
Migraines are beyond typical headache pain as they cause either a pulsing sensation, extreme pain, or both. A migraine may last a few hours to a few days and can even cause nausea, vomiting, and sensitivity to light. A person has chronic migraines if they experience these severe headaches at least 15 days of the month.
Botox is FDA-approved for managing chronic migraines at a dose of 200 Units/4 mL or 100 Units/2 mL every 12 weeks. While not a permanent solution, Botox is proven to help stop migraines before they occur.
“Botox enters the nerve endings around where it is injected and blocks the release of chemicals involved in pain transmission,” says Green. “This prevents the activation of pain networks in the brain.”
Some research has found that about 80% of patients who received botox treatment for migraines experienced at least a 50% reduction in pain after three sessions.
A small 2018 study followed those who saw these results for three years of treatment to identify long-term effects. It found that overall, patients saw a reduction in the number of days per month they experience migraines, as well as the amount of migraine medication they required. Some people decreased their frequency of botox injections after a year from every three months to every four to six months due to improved symptoms.
“Botox has one of the best efficacy profiles we have seen of all the therapeutics to treat migraines,” says Shalini Shah, MD, the vice-chair of the anesthesiology department and director of pain services at the University of California, Irvine.
Are there any risks to using botox for migraines?
Side effects of Botox on the face and neck are the same, whether for cosmetic reasons or to treat migraines.
According to Ilan Danan, MD, MSc, a sports neurologist and pain management specialist at the Center for Sports Neurology and Pain Medicine at the Cedars-Sinai Kerlan-Jobe Institute, potential side effects of Botox include:
- Neck pain
- Discomfort at the injection sites
- Skin irritation
- Face drooping
- Flu symptoms
In severe but uncommon cases, the toxin in Botox may spread to other areas of the body. This can lead to difficulty swallowing and breathing, says Shah. If this occurs, call a doctor immediately.
To help mitigate risks, Danan and Shah say to avoid getting Botox if you are:
- Pregnant or might become pregnant
- Allergic to Botox
- Experiencing a skin infection
- Diagnosed with a neurological disease such as amyotrophic lateral sclerosis (ALS) or Myasthenia Gravis (MG)
What to expect when using botox for migraines
If you choose to use Botox for migraines, a board-certified physician for Botox — usually a neurologist — can administer the treatment. They will inject it in the forehead, above and between the eyebrows, the base of the skull, and the neck, says Green. These spots are points of discomfort for migraines.
Botox injections only take a few minutes and should not cause much pain. After receiving treatment, keep your head upright for a minimum of four hours and avoid massaging the injected areas for three days.
“Rubbing the area of treatment can result in moving Botox to unwanted areas. Botox is superficially injected, therefore, it needs an adequate amount of time without movement for it to dissipate fittingly,” says Green. Refrain from exercise the day of treatment as it can increase your blood pressure, potentially causing bruising and swelling.
Patients can begin to feel migraine relief within seven to ten days following treatment, says Shah. However, Danan adds that some people may require multiple sessions to feel results.
“After the injection, we typically see the most efficacy at the six-week post-injection mark, and then relief until the toxin disassociates from the receptor at 12 weeks,” says Shah.
Botox injections are proven to help patients with chronic migraines by freezing nerve terminals, which produce pain and relaxing the muscles. Most insurance companies will cover Botox as a migraine treatment as long as two other forms of migraine medication did not work for you.