As you may already know, Botox® injections are an effective migraine treatment—in fact, Botox® has been FDA-approved for migraine for about a decade. But have you ever wondered how a cosmetic procedure more commonly associated with wrinkles works to treat debilitating migraine headaches?
We thought you might be curious, so we did the research for you and wrote this guide to how Botox® treats migraine—and how to tell if it might be a good idea for you to try it.
You probably already know Botox® is a cosmetic treatment injected into your skin. But you might be surprised to find out what’s actually in those syringes.
Botox® is short for botulinum toxin (also called botulinum neurotoxin or BoNT), a neurotoxin made by a bacteria called Clostridium botulinums. This toxin is part of what makes spoiled food dangerous—if you ingest botulinum toxin, it can cause a potentially fatal reaction known as botulism.
Before you get scared off, keep in mind that only happens if you ingest it. Botulism’s lethality comes from the fact that it paralyzes your muscles, so it makes sense that in smaller doses, it has a similar (and thankfully less dangerous) effect. By purifying the toxin and using very small amounts, dermatologists are able to use it to temporarily reduce muscle contractions in your face, minimizing the visibility of wrinkles.
Some migraine sufferers think the Botox® used to treat migraine is somehow different from the Botox® used for wrinkles, but that’s actually not the case—neurologists and dermatologists are using the exact same treatment. In fact, the link between Botox® and migraine was first discovered by women who were just trying to smooth out some fine lines when they realized the treatment also helped their migraine.
Once you understand what Botox® is, it’s easy to see how it could be useful for medical as well as cosmetic purposes. For people with cerebral palsy, for example, its muscle-relaxing effect can help keep involuntary movements under control. Botox® can also help treat a lazy eye, which is usually caused by an imbalance in the muscles around the eyes. But with a condition like migraine, the connection is a little more complicated.
So how does it work? Here’s that complicated bit we told you about. Doctors suspect that when it’s injected into the places where a migraine sufferer typically experiences pain, Botox® has its usual paralyzing effect—but this time under the surface. Instead of stopping your face muscles from moving around, it keeps the nerve endings in your brain (your neurotransmitters, to be exact) from releasing pain signals. (Some experts think it might also block CGRP, a protein that makes attacks more frequent.) That’s why Botox® is used as a preventive rather than acute migraine treatment—it can’t stop an attack that’s already happening, but it can make your head less likely to start hurting in the first place.
The FDA sure thinks so—it approved Botox® as a chronic migraine treatment back in 2010, after two big studies published in Cephalalgia and Headache proved it could be effective. A more recent analysis of 17 studies with a total of 3,646 participants concluded that that research still holds up a decade later. Botox® not only reduced participants’ number of headache days better than placebo, but also did so with few side effects.
On average, Botox® can prevent eight or nine headache days a month (versus six or seven for placebo), but it takes time to kick in. You might have to get two or three rounds of injections before you notice a difference. And once it starts working, you need to get regular injections to maintain the lower headache frequency, because Botox® wears off after a few months.
Wondering what you can expect if you opt for Botox® treatment? Your first appointment will only take about 20 minutes. Using a very small needle, your doctor will inject Botox® into the muscles on your head and neck. The injection sites will differ depending on where you feel pain during a migraine, but you can expect to get anywhere from 20 to 40 shots in one session. As scary as that might sound, you can go home right after the procedure and go on with your life, no bed rest required.
And if you’re hoping to get a little boost to your skin’s appearance while you’re at it, just ask your doctor to keep the injections symmetrical and aligned with the wrinkles you’re trying to smooth. Because why not kill two birds with one stone when it’s this easy?
After your first treatment, you may need to wait 12 weeks and then do another round before you can figure out if it’s effective for you. Some sufferers don’t see results until their third treatment, which means you may end up waiting a full six months just to find out Botox® doesn’t work for you. If it does work, all you need to do is keep getting the injections every 12 weeks, which only adds up to four times a year.
Nearly every medical treatment comes with some risk of side effects, and Botox® is no different. Luckily, Botox® side effects are pretty mild. The most common one is neck pain, which can be eased with an ice pack or hot compress.
Other potential side effects of using Botox® include:
Some people are allergic to Botox®. If you get hives, shortness of breath, or swelling in your legs after getting Botox® injections, call your doctor immediately.
Assuming you’re not afraid of needles, Botox® might seem like an appealing option for keeping your attacks under control without having to remember daily medication. But there are a few factors you’ll want to consider before you make your first appointment.
Botox® is only FDA-approved for chronic migraine, so you’ll need to meet that criteria before most doctors will give it to you. You have chronic migraine if you have 15 or more headache days a month (even if not all of those headaches are severe enough to be considered migraine attacks). If your attacks are less frequent than that, you probably have episodic migraine. If you haven’t been tracking your attacks, this quiz can help you figure out which category you fall into.
You can’t give yourself Botox® injections at home, so you’ll need to be able to get to your doctor’s office on a regular basis. If you’re using Botox® for migraine, your first step will be finding a doctor with experience doing this, like a headache specialist or a neurologist. The American Migraine Foundation’s doctor database could be a good place to start.
These days, though, it’s not enough to just consider experience. To avoid exposing yourself to unnecessary risk, you’ll also have to take into account how far you’ll need to travel to get to the office and how you’ll get there. For example, if public transit isn’t a safe option and you don’t have a car, you might have to try to find a doctor within walking distance of your home.
The FDA-recommended dose of Botox® for migraine can cost anywhere from $300 to $600 per treatment (not including the price of the procedure itself and any other fees your doctor might charge), which is nothing to sneeze at. But since it’s FDA-approved, you might be able to get your insurance to help cover the cost. Note that most major insurance companies won’t cover Botox® unless you’ve already tried two other preventive treatments without success, so you might want to try anticonvulsants, antidepressants, or beta blockers before you turn to Botox®.
If all this has you thinking that maybe Botox® isn’t the best option for you right now, we’ve got you covered. In addition to the medications we just mentioned, you could also consider anti-CGRPs, supplements, or lifestyle changes like getting more exercise or improving your stress management. You can find details on the pros and cons of each of these in our guide to Botox® alternatives.
Let’s recap. Botox® is an effective preventive treatment for chronic migraine that comes with minimal risk of serious side effects. But it’s expensive, inconvenient, and by no means guaranteed to work for you.
If your attacks are taking over your life, a Cove doctor can recommend the right preventive treatment for your needs. Plus, we’ll deliver it directly to your door—no office visits required. Get started today with an online consultation.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Photo by Karelys Ruiz on Unsplash