What To Know About Botox For Migraines

What To Know About Botox For Migraines

Everybody can relate to the pain of a migraine. The sharp discomfort, queasiness, and pounding in one’s head. Sometimes it’s so horrible that you just want to sleep for days in a row. But, there are situations when that isn’t possible. If you’re one of the millions of individuals who get migraines, you understand how debilitating they can be.

The good news is that there are medications available that can reduce or eliminate these symptoms. Botox injections are among the options for treating migraines.

Botox is a revolutionary migraine medication with few side effects and no cure. Botox for migraines helps to lessen the painful symptoms of migraine pain by relaxing tense muscles in your head and neck that can contribute to headaches. Although Botox is safe and effective, there could be other causes for your pain aside from migraine so it’s better to get to know more about it before deciding if it’s right for you .Read on to learn more How Many Units Of Botox For Migraines and How Does Botox Help Migraines.

What To Know About Botox For Migraines

Botox’s effect on migraines was discovered coincidentally when people who were having Botox injections to lessen lines and wrinkles in their foreheads noticed that their headaches were improved. That’s when ‘off-label’ uses of Botox began, and its manufacturer began pursuing FDA approval and insurance reimbursement for medical uses.

Dubbed as the “little neurotoxin that could,” by USA Today, Botox now boasts sales of well over $1 billion for its manufacturer, Allergan. Many of us who start to see our Migraine-furrowed forehead lines show up in our 30s think: hey, maybe Botox for Migraine could help me too.

But before you say “heck yes!” at the next Botox party or med-spa, be sure you know what you’re getting into.

Now widely used for over a dozen different conditions, from teeth-grinding to sweaty palms to spasticity to vaginal spasms, Botox is a mega-drug. And to think that not so long ago botulinum toxin meant a bulging can of poison. It’s now deemed quite safe in the hands of a medical professional, and about half of all uses are cosmetic.

Not Just for Wrinkles: What to expect from Botox for Migraine

If you’re struggling with Chronic Migraine and want to know whether to try Botox, it’s wise to know what not to do. Here’s what you need to know:

1 – It’s Only Approved for Chronic Migraine

“Why can’t I get Botox for migraines?” asks a woman who loses 10 days a month to her attacks. Good question. Whether or not it will help you really depends on the frequency of your attacks.

“While there is no evidence-based data to support Botox for episodic Migraine or tension headaches, some clinicians will ‘fudge’ the indication to include high-frequency episodic (HFEM) patients who have not had success with other preventatives,” Dr. Cowan told us. The American Migraine Foundation defines HFEM as 10-14 headache days per month.

Clinical Evidence for Botox for Chronic Migraine

The FDA’s decision to approve Botox for Chronic Migraine (but not episodic) was based on the existing evidence, namely two clinical trials called PREEMPT. The two PREEMPT trials included only patients with Chronic Migraine.

Results from the first PREEMPT trial showed those who received Botox had 7.8 fewer headache days a month, while those who were injected with placebo had 6.4 fewer headache days.

In PREEMPT 2, those who received Botox experienced 9 fewer headache days a month compared to 6.7 fewer days among those who received a placebo.

These two pivotal, placebo-controlled trials showed that Botox was associated with two fewer headache days a month (6-7 days vs. 8-9 days for placebo) for people with Chronic Migraine and chronic daily headache.

For episodic Migraine or tension-type headache, on the other hand, the clinical proof just isn’t there. A recent meta-analysis of 17 studies looked at data from nearly 3650 patients, of whom 1550 (46%) had Chronic Migraine and the remaining had episodic Migraine.

The review confirmed that Botox is superior to placebo in reducing headache days among those with Chronic Migraine. Studies of episodic Migraine, however, failed to produce statistically significant results.

 If your attacks are on the high end of episodic Migraine, though, you may have some luck.

Some clinicians will prescribe Botox for high-frequency episodic Migraine

“I think clinical experience trumps any meta-analysis,” said Dr. Robert Cowan. “High-frequency episodic patients who failed multiple preventive therapies were not specifically studied in the PREEMPT trial, but my clinical experience has shown Botox to be equally effective for HFEM and Chronic Migraine.”

What about tension headaches? Dr. Cowan warns, “However, I strongly doubt Botox would be effective or appropriate for episodic tension-type headache.”

Our advice

Track your attacks so you know exactly how many days per month you’re losing to Migraine and headache symptoms.

2 – The Clinical Benefit is Comparable to CGRP

Botox is considered a preventive, not abortive, medication for debilitating Migraine attacks. Even for those with Chronic Migraine, though, the effect may only be “small to modest” when compared to placebo, says Dr. Jeffrey Jackson, author of a 2012 study.

Still, Dr. Jackson said, “If I was having more than 15 migraines a month, I’d give Botox a try. It has few side effects. And, if it helps, you can go 90 days without as many headaches and without daily side effects.” Dr. Jackson is a professor of medicine at the Medical College of Wisconsin in Milwaukee.

More recently, the previously mentioned meta-analysis showed that along with fewer headache days, Botox also decreased symptoms of depression and increased the quality of life.

More so, the American Headache Society included Botox in its list of Migraine preventative treatments with established efficacy.

 There are no head-to-head clinical trials comparing Botox to the new CGRP meds, so we asked Dr. Cowan to help us compare the two.

“In terms of efficacy, my clinical experience with Botox and CGRP monoclonal antibodies has been roughly the same,” said Dr. Cowan. “Once the monoclonal antibodies have been around longer, we will know more, but it is too early to tell.”

Our advice

Read the research for yourself. Compare those clinical results with the new anti-CGRP preventative medications.

3 – Botox for Migraines Side Effects Include an Aching Neck

Botox for Migraine side effects aren’t widespread (less than 10% of patients are affected), but they’re painfully real.

According to Allergan’s own Botox for Migraine website, the most common side effect seen in Chronic Migraine clinical trials was neck pain, experienced by approximately 9% of people. Yet because neck pain is also a symptom of Migraine, it’s not clear whether all the reports of neck pain side effects can be attributed to Botox.

Rarer side effects are:

• headache
• Migraine (how ironic!)
• slight or partial facial paralysis
• eyelid drooping, bronchitis
• musculoskeletal stiffness
• muscle weakness
• pain in one or more muscles, ligaments, tendons, or bones
• muscle spasms
• injection-site pain
• high blood pressure

That’s enough to generate buzz on the patient forums like RealSelf among those who have tried it. Botox for migraines reviews include:

“My neck is killing me.”

“Stiffness, pain in the neck, headache and can’t look down.“

Like anything, results vary widely.

For some people, the benefit outweighs the risk. One person said: “I’ve had 6 rounds of Botox for migraines. I had what I would consider neck stiffness after the first couple of rounds. No headaches except for very slight ones and only a handful [of them].”

Our advice

Check out the 400+ comments from the Migraine Again community on their Botox experience below. And remember: every person can have a different response to the same medication.

4 – You May Look A Bit Different

Many people are drawn to Botox for the perceived cosmetic benefit, but the Botox for migraines injection sites are different from those used for cosmetic purposes. So you can’t count on looking like a movie star if your goal is Migraine prevention.

As anyone who’s tried Botox for Migraine (or wrinkle reduction) will tell you, your forehead may feel heavier after the injections are done, where the nerve endings are in essence frozen.

In my case, my usually expressive face didn’t track with my emotions: no raised eyebrows of surprise or delight or shock. So people told me I looked tired, overlooking the grape-sized purple bruise smack dab in the center of my forehead (see #5 below).

As one RealSelf reviewer wrote: “My head feels too tight, my eyebrow position has dropped enough to lose my nice pretty arch and my eyelids seem hooded. My eyes look smaller.”

If it works, though, looking a bit tired or different is a small price to pay for a few more days each month of Migraine freedom and function.

5 – Physician Experience Matters

Sadly, I learned this lesson the hard way. First, I tried Botox in the hands of my neurologist when it first came on the market, and he didn’t have much experience administering it (hence the big bruise).

Later, I tried a highly recommended plastic surgeon, wrongly assuming that his extensive Botox experience trained him to treat Migraine, too.

At each American Headache Society meeting, Allergan invests in educating the attending physicians on the most effective injection sites and methods for Chronic Migraine patients. Find one here.

Who trains those doctors on Botox for Chronic Migraine? World-leading experts like Bronwyn Jenkins MD in Australia and Andrew Blumenfeld MD in the US. Discover the proper procedure and much more during their Migraine World Summit interviews in 2018 and 2019, respectively.

HealthDay quoted NY neurosurgeon Dr. Ezriel Kornel: “If done properly, there really aren’t substantial (side) effects from the use of Botox. But, over time the effect may wear off. Some people can develop an immunity to Botox.”

Our advice

Find one of those Allergan-trained doctors and ask them exactly how many Botox for Migraine procedures they’ve done.

6 – It Takes 6-9 Months to Give it a Fair Trial

To give Botox for Migraine a fair trial, you’ll need to undergo the injections 2-3 times over a 6-9 month period. It takes some time to re-train the muscles to relax, apparently.

Some patients report that their side effects vary each time they have it done. But relative to oral preventative medications like Topamax and Elavil, Botox for migraine has very few side effects.

Even better, there is good evidence that when it does work, Botox has a cumulative effect and works better and better with each cycle.

“Therefore, patience is a virtue and trying Botox for 2–3 cycles may yield benefit not seen with just one set of injections. However, after 2–3 sets of injections, if no improvement is noticed, it should probably be discontinued,” writes headache specialist Dr. Deborah Tepper.

The American Headache Society recommends trying Botox for a minimum of 6 months.

“It is possible that the placebo effect produces some of the positive health outcomes that come from Botox, “Dr. Robert Cowan told us, “but it doesn’t really matter. If the placebo effect prevented patients from doing something better, it would be worth discussing, but Botox (or any preventive) should never be the sole treatment strategy. Lifestyle and acute treatments should be part of every treatment plan.”

Our advice

If you’re going to try it, don’t give up after the first try, and reconsider whether you’re a good candidate after three tries.

7 – Effects May Wear-off Between Treatments

Although Botox is administered every 3 months for Chronic Migraine, some patients experience wear-off 2-4 weeks before their next injection. A 2019 retrospective study looked at the chart of 143 people who received Botox for Chronic Migraine over a 2-year period. Wear-off was reported in 90 participants (63%).

Those who experienced wear-off received significantly fewer units of Botox per session compared to the group that did not experience wear-off. The study authors conclude that clinicians may consider increasing the units of Botox used to reduce the risk of wear-off.

Our advice

Work with a doctor or nurse practitioner who is skilled in giving Botox for Chronic Migraine. Discuss with him or her the option of using more units during your sessions, especially if you experience wear-off before your next session.

Botox for Migraines Cost vs. Benefit

Costs to consider

• immediate out-of-pocket costs
• long-term higher cost of insurance
• your time
• the pain of injections

What will your total monetary cost be? That depends on your insurance. If you have Chronic Migraine and commercial insurance, you’ll likely have coverage.

“In 2018, about 96% of insurance benefit verification covered Botox for Chronic Migraine,” said Lisa Hughes, Director of Advocacy Alliance for Allergan. “Based on 2017 claims data, the average out of pocket for drug cost is $177.06. There is an additional cost for the physician to administer.”

The Coalition for Headache and Migraine Patients (CHAMP) has a handy guide to the financial assistance programs available for Botox. Access it here. You may be also able to save some money through the Botox Savings Program.

Of course, there’s also the needle pain. Botox injections can be quite painful – especially if you’re experiencing an active Migraine attack. It’s important to stay on schedule for Botox for Migraine to fully work, though, so reschedule at your own risk.

Benefits to consider

• more days back on your calendar
• a higher probability of being able to show up for work/family/fun
• fewer wrinkles

If it works for you, you saved an average of 12 headache days over a 6-month period as a result.

How Many Units Of Botox For Migraines

Botox is injected around pain fibers that are involved in headaches. Botox enters the nerve endings around where it is injected and blocks the release of chemicals involved in pain transmission.

• The recommended total dose of Botox (onabotulinumtoxinA) for chronic migraine prevention is 155 Units administered into a muscle (intramuscularly).
• This is given as 0.1 mL (5 Units) injections divided across 7 specific head and neck muscle areas, for a total of 31 individual injections per session. You should receive these injections from a medical specialist that is trained in Botox injections.
• The areas that are injected with Botox for migraine prevention include the forehead, bridge of the nose, the temples, the neck, the back of the head, and just above the shoulder blades in the upper back. The injections are given with a small needle and may feel like a tiny pinprick.
• Injections take about 15 minutes and you can usually go back to your normal routine afterwards.

Botox is used in adults to prevent chronic migraine headaches that occur on 15 or more days per month and that last at least 4 hours.

Infrequently Botox may cause loss of strength or general muscle weakness, vision
problems, or dizziness within hours to weeks of taking Botox. If this happens, do not drive a car, operate machinery, or do other dangerous activities

How often do I see my doctor for Botox injections for migraine?

You will usually start with 2 treatments spaced 12 weeks apart. Once you and your doctor see how you respond to Botox for migraine, you will then continue treatments every 12 weeks if it is working well for you.

The recommended retreatment schedule of Botox for migraine prevention is every 12 weeks. This means you will only need to receive injections 4 times per year or as directed by your healthcare provider.

How quick does Botox work for migraine headaches?

In studies, some patients felt headache results as soon as 4 weeks. If Botox for migraine prevention works for you, you should usually see results after the second set of injections at 12 weeks.

In 6-month long studies, patients continued to see reductions in their number of headache days on most days over the study period. Botox also lowered the total length of time of headaches on days when they occurred over the study period, when compared to placebo (an inactive treatment).

• Botox is used as a therapeutic treatment for many conditions, including for prevention of migraine headaches, and Botox Cosmetic is used for aesthetic purposes to lessen wrinkles like crow’s feet or forehead lines.
• Botox and Botox Cosmetic are prescription medicines that both contain the active ingredient onabotulinumtoxinA, but they come as separate products.
• Originally when Botox was first approved for wrinkles, doctors found it all also helped patients with migraine headaches. It was eventually approved by the FDA for migraine prevention in 2010.
• Both treatments are given as injections into the muscles of the face, neck or head, depending upon the use. You will need more injections per session for migraine prevention than for wrinkle treatment.
• Botox (for the treatment of chronic migraine) and Botox Cosmetic are for use in adults only.

Learn More: Compare Botox vs Botox Cosmetic

In addition to prevention of chronic migraine headache in adults, Botox is also approved to treat:

• overactive bladder
• leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease
• muscle spasticity
• cervical dystonia (abnormal head position and neck pain)
• certain types of eye muscle problems or eyelid spasms
• severe underarm sweating

Botox Cosmetic is approved for adults to temporarily help improve the look of moderate to severe facial wrinkles:

• forehead lines
• crow’s feet lines
• frown lines between the eyebrows.

Botox Cosmetic is supplied in different unit vial sizes from Botox.

• Botox used for migraine comes in 100 and 200 unit single-use vials, while Botox Cosmetic for wrinkles comes in 50 and 100 unit single-use vials.
• Reconstitution and dilution instructions in the package insert vary between these two products.
• Potency Units of Botox Cosmetic or Botox are not interchangeable with other preparations of botulinum toxin products.

Botox dose for migraine: The recommended total dose for chronic migraine is 155 Units, as 0.1 mL (5 Units) injections per each site divided across 7 head/neck muscle areas, for a total of 31 individual injections. These areas include the forehead, bridge of the nose, the temples, the neck, the back of the head, and just above the shoulder blades in your upper back.

Botox Cosmetic dose for wrinkles: The recommended dose for wrinkles varies based on wrinkle type and typically ranges from 20 to 24 units per wrinkle area. The units per injection site will vary by patient and can be determined by a qualified injector for optimal results.

Can I get Botox and Botox Cosmetic at the same time?

Yes, you can receive Botox and Botox Cosmetic for different uses at the same time as long as the total dose received of onabotulinumtoxinA does not exceed 400 Units administered in a 3 month period for adults.

You may also receive Botox Cosmetic treatment for treatment of different wrinkle areas at the same time. It is not known if Botox Cosmetic is safe and effective for use more than once every 3 months.

The dilution and the resulting units per 0.1 mL (as noted in the package insert) are different between Botox and Botox Cosmetic. Health care providers should see the specific instructions for reconstitution and administration of each product.

Warnings: Botox and Botox Cosmetic may cause serious side effects that can happen hours, days, or weeks after an injection and can be life threatening. These include:

• Problems breathing or swallowing
• Spread of toxin effects (leading to symptoms of a serious condition called botulism)

Call your doctor or get medical help right away if you have any of these problems after treatment.

According to the manufacturer, there has NOT been a confirmed serious case of spread of toxin effect away from the injection site when Botox has been used at the recommended dose to treat chronic migraine or when Botox Cosmetic has been used at the recommended dose to treat approved wrinkle areas.

What are Botox or Botox Cosmetic side effects?

• dry mouth
• discomfort or pain at the injection site
• tiredness
• headache
• neck pain
• eye problem
• drooping eyebrow
• urinary tract infection and painful urination
• inability to empty your bladder
• allergic reaction
• upper respiratory tract infection

Review these warnings and side effects in this Medication Guide for Botox and Botox Cosmetic. Tell your doctor if you have a side effect that does not go away or that concerns you.

Bottom Line

• Botox Cosmetic is used for aesthetic purposes for wrinkles and Botox is used as a therapeutic treatment for many medical conditions, including migraine headache prevention.
• Botox Cosmetic and Botox come as separate products but are both prescription medicines that contain the active ingredient onabotulinumtoxinA.
• The number of injections needed for migraine prevention are more than the number needed for wrinkle treatment.
• Both products are given as injections into the muscles of the face, neck or head, depending upon the use. You can receive both products as long as the total amount does not exceed 400 Units administered in a 3 month period for adults.

This is not all the information you need to know about Botox or Botox Cosmetic for safe and effective use for migraine. Review the full Botox or Botox Cosmetic information here, and discuss this information and questions with your doctor or other healthcare provider.

How to qualify for botox for migraines

I’ve suffered from migraine headaches since I was in my early teens. Over the years, I’ve missed out on much-anticipated trips, concerts, and family parties as I lay in bed with my head throbbing and the lights off. Migraine makes it nearly impossible to plan in advance and turns you into a flaky friend, which takes a toll on your relationships.

I thought I had tried everything-Advil, beta-blockers, Topamax-but none of them gave me the results I was looking for. Then a few years ago, my neurologist suggested I try Botox to manage my migraines. I knew about the drug’s wrinkle-reducing effects (I watch the Real Housewives franchises and Keeping Up With the Kardashians, after all), but I didn’t know that the same drug is a well-regarded preventative treatment for chronic migraine.

Admittedly I was hesitant about getting dozens of shots injected into my head, neck, and shoulders on a regular basis, but my misery made me open to trying it. Despite my initial concerns, Botox shots have completely changed how I control my migraine attacks. Though I’m still good for one or two migraines each month, Botox has drastically reduced the frequency of these attacks.

How Does Botox Help Migraines

The recommended total dose of Botox (onabotulinumtoxinA) for chronic migraine prevention is 155 Units administered intramuscularly (into the muscle). This is given as 0.1 mL (5 Units) injections divided across 7 specific head and neck muscle areas, for a total of 31 individual injections per session.

Botox is only FDA-approved for chronic migraines, which means headache on 15 or more days a month.  “The more frequent the headaches, the better the patient does with Botox,” says Dr. Andrew Blumenfeld, Director, The Headache Center of Southern California. Botox is not recommended for patients who experience fewer than 15 headache days a month.

What is Botox?

Botox is a form of botulinum toxin, a neurotoxin produced by the bacteria that causes botulism. When the Botox botulinum toxin is purified and used in tiny doses in specific areas, it temporarily reduces muscle contractions for approximately 3 months.

How Does Botox Work?

Botox is injected around pain fibers that are involved in headaches. Botox enters the nerve endings around where it is injected and blocks the release of chemicals involved in pain transmission. This prevents activation of pain networks in the brain.

Botox prevents migraine headaches before they start, but takes time to work. “I look to the second and third treatments to maximize effects,” says Dr. Andrew Blumenfeld. “Patients see in

creasing benefit with an increase in the number of treatment cycles.” One treatment lasts for 10-12 weeks, and patients reported that two Botox treatments reduced the number of headache days by approximately 50%.

Who Uses Botox for Migraine?

The FDA approves the use of Botox to treat chronic migraine in adults who are age 18 or over.  Botox is considered an “off-label” treatment if it’s used for children or adolescents. This means that a doctor can prescribe it, but insurance companies might not pay for it.

Finding a Doctor Who Treats Migraine with Botox

If you want to try Botox for migraine, you should look for a headache specialist or neurologist. We recommend using your insurance’s doctor listing, Yelp, or the American Migraine Foundation’s doctor database.

Dr. Laura Banks, neurologist at Natividad Medical Center, suggests asking prospective doctors where they learned to give Botox, and how many times they’ve given it. “You’re looking for a lot of experience,” she says. Dr. Andrew Blumenfeld suggests asking doctors how many injections they will give, and where they will give them.

Getting Botox Treatment Paid for by Insurance

In general, the FDA-recommended dosage of 155 units costs between $300 to $600 for each treatment. Because Botox is FDA approved for chronic migraine, it’s covered by most plans, including Medicare and Medicaid. Allergan offers a “Botox Savings Card,” which offers patients reduced fees.

Please note that before your insurance company will approve Botox as a treatment for your chronic migraine, you typically must have tried and failed to respond to two other preventative treatments. These might include anti-seizure medications, antidepressants, or blood pressure medications that are typically used to prevent migraine.

What is Botox Treatment Like?

When you receive your first Botox treatment, expect the appointment to take about 20 minutes. The doctor uses a very small needle that feels like a pinprick. He or she injects small amounts of Botox into shallow muscles in the skin. Each treatment typically involves 31 injections in seven key areas of the head and neck.

The most common side effect from the Botox shots is a sore neck, and we recommend using an ice pack to reduce the discomfort.

It can take up to six months to see the maximum benefit from Botox. In the meantime, you can continue your regular medications with no risk of a drug interaction.

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

 The 14 Different Kinds Of Headaches You Can Get-And How To Treat Each One

Most people believe a migraine is just a bad headache, but it can be more than that. According to the American Migraine Foundation (AMF), a migraine (sometimes just referred to as “migraine”) is a “disabling neurological disease with different symptoms and different treatment approaches compared to other headache disorders.”

It’s also important to note that, while some headaches can be the cause of underlying conditions (those are known as secondary headaches), 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, tells Health.

“Pain is often the predominant symptom, though many patients have other symptoms that can actually be more bothersome than the pain itself,” says Dr. Najib. Ferhad Bashir, MD, a neurologist with Mischer Neuroscience Center at Memorial Hermann The Woodlands Medical Center in Texas, goes a step further: “It’s a state of misery,” he tells 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.”

Those additional symptoms, 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 that there’s a genetic component to the neurological condition, according to the US National Library of Medicine’s MedlinePlus resource. But the condition-which affects more than 37 million people in the US alone-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, per the AMF, which points to 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, North Carolina, tells Health. “We also have changes in migraine frequency in pregnancy and postpartum, as well as related to perimenopause.”

There’s no cure for migraines, per MedlinePlus. Instead, treatment mainly focuses on relieving symptoms and preventing or lessening future attacks through a combination of medications and lifestyle changes. This, in some cases, is where Botox-aka Onabotulinumtoxin A or Botox A-comes into play.

 5 Women on What It Really Feels Like to Have a Migraine

How does Botox for help migraine?

Botox is a preventative therapy for migraine, meaning that it can reduce the frequency of migraine, but it won’t stop one once it’s begun. Though Botox has been an FDA-approved treatment for chronic migraine for more than a decade, per the AMF, the science behind how it battles the disease is still a bit of a mystery.

Technically speaking, the AMF says that Botox is injected into the pain fibers in the head, neck, and back that are involved in headaches. That Botox then blocks the release of chemicals involved in pain transmission, which then prevents activation of pain networks the brain.

Why Botox works in this way, however, 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,” says 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 percent, per the AMF), Dr. Najib notes that the drug isn’t a cure-all. “As long as the disease is still active, you’ll have breakthrough headaches,” he says.

Because of that, some patients find that they need another preventative treatment, like an oral medication, in addition to their shots. It’s also common to need a rescue drug, and the risk of drug interaction is minimal.

Choosing a treatment of preventative method for migraine is a highly personal choice that should be done in close contact with your doctor. Here’s more of what I learned about Botox and migraine during my own journey-and what I want those considering the treatment to know.

 This Explains Why You Want to Crawl Into a Dark Closet When You Have a Migraine

It’s only approved for chronic migraine

Botox is FDA-approved to treat chronic migraine in adults, which is defined as more than 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 them, 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. Every three months you’ll receive 31 shots (yes, you read that correctly) totaling up to 155 units of Botox. This 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 is working for you, there’s no known health risk associated with staying on it indefinitely, though it’s not approved for people who are pregnant or breastfeeding because of minimal studies in these 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, Arizona, tells 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.”

In fact, 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,” says Dr. Bashir.

Your insurance may or may not cover it

Because it’s an FDA-approved treatment, your health insurance may cover all or most of the cost of Botox, though this depends on your specific plan. The drug manufacturer also offers a savings program that can help offset some of the expense.

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 (I track mine in a note on my phone) that shows you’re having 15 or more headache days per month.

Once you’ve started the shots, your insurance will probably require documentation of improvement to continue paying for the treatment. Depending on your plan, you may also need to come for a follow-up visit between shots.

Note, however, that if Botox is used as an off-label treatment (meaning it’s used in a way not approved by the FDA, like in children or adolescents), insurance companies may not cover it, per the AMF.

It can take several months to see results

If you don’t experience relief from migraine right away, don’t swear off the treatment immediately. Dr. Najib recommends trying two rounds of Botox before making a decision about whether it’s working for you. Even if the treatment ends up helping after the first round, he says results typically take two to four weeks to kick in. There’s no taper required to discontinue the treatment.

It’s a little different than 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 varies depending on your goals.

You may find some level of 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 you would in a doctor’s office. This means you’ll miss the drug’s full migraine-busting effect.

You can technically get Botox for migraine and for cosmetic reasons at the same time-but you may not want to

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

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

Overall, if you’re finding yourself planning your life around your migraines, you may want to make it a point to chat with your doctor about using this multitasking drug to reduce the frequency of the attacks. I know doing so has drastically changed my life-and it might help you, too.