Botox, which is the brand name of a form of the botulinum toxin known as onabotulinum toxin A, first received approval from the U.S. Food and Drug Administration (FDA) in 1989 for treatment of a condition called strabismus, or crossed eyes. Over the years, its official use was expanded to encompass a number of other conditions, such as excessive underarm sweating, or axillary hyperhidrosis. Botox finally got the nod for chronic migraine treatment in 2010. If you’re one of the 4 million people who suffer from chronic migraines—that is, migraine headaches affect you at least 15 days out of every month—you may be interested in this treatment. It won’t cure your headaches or get rid of them entirely, but it might help. “What you see over time is a reduction in frequency and severity of headaches,” says neurologist and headache specialist Dr. Nada Hindiyeh, MD, a clinical assistant professor in neurology and neurological sciences at Stanford Medicine.
What to expect when you get botox for migraines
If you’ve ever gotten Botox injections for cosmetic purposes, then you’re set. You already know what to expect. But if you’re new to this, here’s what you need to anticipate. Essentially, you walk into your doctor’s office and get comfortable in the treatment room. Your doctor will inject 155 units of Botox into your face and neck. But don’t worry: It’s not 155 separate injections. It’s a total of 31 injections, and the needles are very small. Plus, your doctor will work quickly to get them all in. “It’s a very simple procedure,” says headache specialist Dr. Emad Estemalik, MD, section head for Headache and Facial Pain at the Center for Neurological Restoration at Cleveland Clinic. “It takes anywhere between 15 and 20 minutes to conduct. And there’s no sedation required.” Many people just head back to work right afterward. It is possible that the procedure might trigger a headache for you, so you might want to plan a lighter day after your first series of injections, just in case, says Dr.Katherine Hamilton, MD, a neurologist and migraine specialist with Penn Medicine. “But otherwise, it should be fine,” she says. “It sometimes leaves a bit of a red bump on the forehead but that gets better after 10 or 15 minutes.”
How does Botox work for migraines?
Experts believe that injecting onabotulinum toxin A into your head and neck works because it seems to temporarily block the release of chemicals involved in the transmission of pain. And the key word there is “temporarily.” It will wear off, so every 12 weeks, you’ll return to your doctor to receive another 155 units of the toxin. But it’s also not an instant fix—it might take a few weeks to kick in. “Botox isn’t something that is going to work right away to completely take away your headaches. It’s a preventive treatment that works overtime,” says Dr. Hindiyeh. “That’s why I tell people not to get discouraged if you don’t notice the change right away. Everyone is different.” She advises patients to give it a few rounds before deciding whether or not it’s working for them. What constitutes success? Again, it’s not about complexly eradicating migraines. “Onabotulinum toxin A has the ability to reduce someone’s headaches by at least, if not more than, 50 percent,” says Dr. Estemalik. And hopefully, you’ll be able to dial back on the medications you need to treat the acute pain of a migraine. “Over time you will see that you don’t need them as frequently, and they will work even better,” says Dr. Hindiyeh. Another benefit of opting for Botox for chronic migraine prevention: Research suggests that it’s generally well-tolerated. Occasionally, some people will experience some neck pain or neck discomfort after receiving the injections or a slight headache the next day, says Dr. Estemalik, but overall, the side effect profile is “incredibly low.” And because you’re not taking a medication that affects your whole body, you won’t have to worry about systemic side effects. If you’re wondering why Botox injections are recommended for chronic migraines but not for other headaches, Dr. Hamilton explains that studies showed it wasn’t effective for episodic migraines, which occur less frequently. So, if you suffer from episodic migraines or other types of headaches, you’ll need to stick to other types of treatment.
Where do they inject Botox for migraines?
As you might expect, there are specific places where your doctor will inject the Botox. In fact, there areseven key injection sites in your head and neck:
Corrugator muscles, at your eyebrowsProcerus, the space right between your eyebrowsFrontalis, across the top of your foreheadTemporalis, or the side of your head above your earsOccipitalis, at the sides of the back of your headCervical paraspinal, at the lower back of your head muscle groupTrapezius muscles in your shoulders.
Different doctors may start in different locations, but they all hit the same seven sites.
How much does Botox for migraines cost?
Ah, the million-dollar question: How much does it cost? If Botox injections work for you, you’re looking at getting a new round of injections every 12 weeks. That could add up if you weren’t budgeting for it. While the FDA-recommended dosage of 155 units costs between $300 to $600 for each treatment, according to the American Migraine Foundation, you may not have to pay for it out of your own pocket. Because it’s an FDA-approved treatment for chronic migraines, insurance will often cover the cost of Botox injections for this purpose … if you meet the necessary criteria first. First, you need to have a diagnosis of chronic migraine.“That’s someone who has headaches 15 or more days per month,” says Dr. Hamilton. “That’s the cutoff.” Most insurance companies will require that you try at least two or three older medications first. That might include anti-seizure meds, blood pressure medications, or antidepressants. If you don’t respond (or don’t respond very well) to them, then it’s time to try Botox. “Sometimes I wish we could just jump to Botox first, but our hands are tied,” says Dr. Hamilton. Next up, here are 14 expert-backed tips for migraine relief.
Sources
Dr. Emad Estemalik, MD, section head for Headache and Facial Pain at the Center for Neurological Restoration at Cleveland ClinicDr. Katherine Hamilton, MD, doctor of Neurology at Penn MedicineDr. Nada Hindiyeh, MD, headache specialist at Stanford MedicineAmerican Migraine Foundation: “Botox for migraine"FDA: “Botox label information"Neurological Sciences: “The use of onabotulinum toxin A (Botox®) in the treatment of chronic migraine at the Parma Headache Centre: a prospective observational study.” Migraine Research Foundation: “Migraine Facts” Journal of Headache Pain: “Experience with onabotulinumtoxinA (BOTOX) in chronic refractory migraine: focus on severe attacks. Journal of Headache Pain.” Botox Medical: “Proven Injection Sites”
