Treating Migraines With Botox: Here's What You Should Know

You may be aware of the drug's wrinkle-reducing effects, but did you know that Botox is a well-regarded preventative treatment for chronic migraine? 

Botox shots drastically reduce the frequency of migraine attacks in some people—which is sure to be welcome news to anyone whose migraines have caused them to miss out on much-anticipated trips, concerts, and family parties.

If you're a member of the migraine club, please accept our sympathy and read up on these must-know points about Botox for chronic migraine.

First: What Exactly Is a Migraine?

Most people believe a migraine is a bad headache, but it can be more. A migraine (sometimes just referred to as "migraine") is a neurological condition that differs from other headache disorders. That's because a migraine causes unique symptoms and has specific treatment options.

It's also important to note that while some headaches (known as secondary headaches) can be a sign of an underlying condition, migraines are usually their own thing. 

"Migraine is the most common primary headache disorder, which means that it's not happening because of a tumor or an infection. It's just how your brain is wired," Umer Najib, MD, a board-certified neurologist and the director of the headache medicine fellowship program at West Virginia University in Morgantown, W.Va., told Health. "Pain is often the predominant symptom, though many patients have other symptoms that can actually be more bothersome than the pain itself." 

Ferhad Bashir, MD, a neurologist with the Mischer Neuroscience Center at The Woodlands in Shenandoah, Texas, goes further: "It's a state of misery," Dr. Bashir told Health. "During that time period, you're not yourself. If you're at work, you can't produce at your optimum level. If you're a parent, you can't enjoy time with your kids."

Additional symptoms of migraine, aside from often disabling pain, include:

• Sensitivity to light, sound, or strong smells
• Nausea
• Vomiting
• Excessive fatigue
• Language, speech, or balance problems
• Visual disturbances, like seeing zig zags, flashes of light, or blind spots.

It's not entirely clear what causes migraine, though researchers believe there's a genetic component to the neurological condition. But the condition—which affects over 37 million people in the United States—is thought to have quite a few triggers, including stress, anxiety, caffeine (or caffeine withdrawal), and certain medications.

Migraine is also about three times more common in women, indicating a possible connection to fluctuating hormones. 

"For a lot of women with migraine, menses can trigger an attack," Megan Donnelly, DO, a board-certified headache specialist and neurologist, and the director of headache and women's neurology at Novant Health in Charlotte, N.C., told Health. "We also have changes in migraine frequency in pregnancy and postpartum, as well as related to perimenopause."

Unfortunately, there is currently no cure for migraine headaches. Instead, treatment mainly focuses on relieving symptoms and preventing or lessening future attacks through a combination of medications and lifestyle changes. 

That, in some cases, is where Botox—also known as Onabotulinumtoxin A or Botox A—comes into play.

How Does Botox Help Migraine?

Botox is a preventative therapy for migraine, meaning it can reduce migraine frequency. Though Botox has been an FDA-approved treatment for chronic migraine since 2010, the science behind how it battles the disease is still a bit of a mystery.

Technically speaking, Botox is injected near the head, neck, and back pain fibers involved in headaches. Botox impedes the release of chemicals responsible for pain transmission, preventing the activation of pain networks in the brain.

However, why Botox works that way is still not well understood. 

"We have animal data that shows that Botox causes a change in a certain type of calcium channel in the meninges, which is the covering of the brain as well as the critical part of the migraine process," explained Dr. Najib. "We think that's how it suppresses migraine."

Despite Botox's efficacy (patients reported that two rounds of shots reduced their headache days by roughly 50%),

"As long as the disease is still active, you'll have breakthrough headaches," noted Dr. Najib, who added that the drug isn't a cure-all

Because of that, some patients need another preventative treatment, like oral medication, in addition to their shots. It's also common to need a rescue drug.

Choosing a treatment or preventative method for migraine is a highly personal choice that should be made in close contact with your healthcare provider.

It’s Only Approved for Chronic Migraine

Botox is approved by the Food and Drug Administration to treat chronic migraine in adults, defined as a minimum of 15 migraine days per month. It's not approved for other kinds of headaches, like tension or cluster, nor is it approved for children or adolescents (if it's used for those groups, it's considered "off-label use").

You’ll Have To Get Dozens of Shots

Though migraine symptoms vary from person to person, Botox for migraine is standardized. It's likely that every three months, you'll receive 31 shots, totaling up to 155 units of Botox. That includes injections in specific spots in the forehead, temples, back of the head, neck, upper back, and shoulders.

If you've got a particular concern, like muscle spasticity or tightness in the shoulders, your provider may adjust the shot pattern to tackle that specific issue.

If Botox works for you, it is generally possible to stay on it indefinitely. However, it's not approved for pregnant or breastfeeding people because of minimal studies in those groups.

The Risk of Side Effects Is Low

"Botox injections can occasionally trigger a headache, muscle weakness, and neck pain, but this is rare," Kerry Knievel, DO, director of the Jan & Tom Lewis Migraine Treatment Program at Barrow Neurological Institute in Phoenix, told Health. "Eyelid and eyebrow asymmetry and droop can happen, but to prevent this, we recommend that patients refrain from rubbing their foreheads or wearing a hat for 24 hours after their injections to prevent the Botox from spreading from the area we intend for it to be."

Other potential side effects include flu-like symptoms, dry or watery eyes, drooling, pain, swelling, or bruising of the injection area. Additionally, people who are allergic to proteins in cow's milk should avoid Botox.

You'll want to contact a healthcare provider immediately if you experience more concerning side effects, such as:

• Difficulty breathing
• Difficulty speaking or swallowing
• Incontinence
• Muscle weakness
• Vision problems

But ultimately, Botox's limited side effects are part of its appeal. 

"It's not addicting. You don't have to take a pill every day. It doesn't work for everyone, but it does work for a significant amount of people. That's why Botox is amazing," noted Dr. Bashir.

Insurance May or May Not Cover It

Because it's a treatment approved by the Food and Drug Administration, your health insurance may cover all or most of the cost of Botox. However, that depends on your specific plan. 

The drug manufacturer also offers a savings program to help offset some expenses. To get approval, your insurance company may want to see that you've "failed" on two or three oral preventatives first. You may also need to keep a headache diary that shows you're having 15 or more headache days per month.

However, keep in mind: If you use Botox as an off-label treatment (meaning it's used in a way not approved by the Food and Drug Administration, like in children or adolescents), insurance companies may not cover it.

It Can Take Several Months To See Results

If you don't experience relief from migraine immediately, don't swear off the treatment immediately. Dr. Najib recommended trying two rounds of Botox before deciding whether it's working for you.

Even if the treatment ends up helping after the first round, Dr. Najib said results typically take two to four weeks to kick in. There's no taper required to discontinue the treatment.

It’s Different From the Botox You Receive From Your Esthetician

Though the same drug is used for both migraine prevention and cosmetic purposes, the amount and placement of Botox vary depending on your goals.

You may find some relief when you get Botox for cosmetic purposes. However, when you receive Botox from an esthetician, you're not getting injections in the same spots as in a healthcare provider's office. That means you'll miss the drug's full migraine-busting effect.

Getting Botox for Migraine and for Cosmetic Reasons Simultaneously

The manufacturer of Botox recommends not exceeding 400 units in three months. Since your neurologist will administer 155 units, technically, you have wiggle room if you want to visit an esthetician for Botox. However, this can be problematic. It gets a little murky, and opinions vary depending on who you ask.

"There is a theoretical risk of developing antibodies to Botox if it's given more frequently," explained Dr. Donnelly. If you'd like to do both, it's best to check with your provider before booking an appointment with your esthetician.

A Quick Review

Overall, if you're planning your life around your migraines, you may want to make it a point to chat with your healthcare provider about using Botox to reduce the frequency of the painful, dizzying attacks.