What To Expect When Getting Botox For Migraines

You have a migraine. You want it to stop. You go to your doctor and they recommend botox injections. That’s great! But what do you need to know? Botox is a neurotoxin that blocks signals from the nerves in your face and neck to the muscles around them, preventing them from contracting. This makes it an effective treatment for migraine headaches, especially ones that are caused by muscle tension in the head, neck or shoulders (the so-called “tension-type” migraine). Botox can be used to treat both acute migraines and chronic ones.

It’s important to note that botox is not a cure for migraines—it simply treats the symptoms of a headache by relaxing the muscles that cause pain. Botox will not prevent migraines from happening again in the future because it doesn’t address any of their underlying causes or triggers.

Read on to learn more about What To Expect When Getting Botox For Migraines, What to Expect During the Procedure and How To Qualify For Botox For Migraines

What To Expect When Getting Botox For Migraines

While most people associate Botox with its ability to smooth out facial wrinkles, it’s also been approved to work as a powerful treatment for migraines. 

Migraines affect about 10% of people around the world and are about three times more common in women than men. Chronic migraines, which are defined as migraine episodes that occur more than 15 days out of any given month, affect about 1% of people.

Chronic migraines can greatly impact daily life due to the pain and other symptoms they cause. Fortunately, Botox has been shown to be an effective treatment for reducing migraine-related pain. In one study, patients reported experiencing 50% fewer headache days while receiving Botox treatment.

To shine more light on this promising migraine treatment, Florida Medical Clinic neurologist Dr. Carrie Downey explains some of the benefits of Botox for migraines, and what patients can expect during a typical Botox treatment. 

How Botox Works for Migraines

Botox works by reducing muscle contractions and stopping  neurotransmitters from sending pain signals to your brain. This can help reduce the pain caused by migraines and lets many patients enjoy daily life without interruption.

The effect is only temporary, so patients will need to receive ongoing treatment. The most common treatment timeline involves an injection every 12 weeks, or four times per year. It may take several weeks to experience migraine relief after an injection. Your doctor may adjust this timeline according to your individual needs.

What is Botox? Is it safe?

Botox is created from botulinum toxin. While the idea of being injected with a toxin may sound scary, Botox actually contains such a miniscule amount of toxin that there is little chance of dangerous side effects. Since 2010, the FDA has recognized Botox as a safe treatment for migraines when administered by a licensed medical professional.

Who qualifies for treatment?

Dr. Downey says that not everyone who struggles with migraines may be eligible to receive Botox treatments. Botox is only recommended for people who fit the following criteria for chronic migraines:

• Experience headaches for more than 15 days a month where at least 8 days involve migraines that last at least 4 hours each
• Struggle with the above for at least 3 months
• Are at least 18 years old

Depending on your symptoms, your doctor may recommend you try other medications or treatments before trying Botox.

What’s the difference between a headache and a migraine?

Botox is an approved treatment for those who struggle with headaches for more than 15 days per month and experience migraines for at least 8 of those days. But what’s the difference between a headache and a migraine?

Headaches can cause pain in different parts of the head according to their cause.

• Some headaches may be caused by physical or psychological stress (tension headaches)
• Others are caused by sinus pressure (sinus headaches)
• Cluster headaches refer to particularly intense headaches that tend to happen around the same time each day

On the other hand, migraines often involve other symptoms aside from head pain. They may include dizziness, nausea, sensitivity to light or sound, as well as severe fatigue (tiredness). Migraines may occur in different phases, which may involve symptoms and signs like blurred vision, mood disturbances, and trouble with speech.

What to Expect During the Procedure

Botox appointments are very quick and can be done right in your doctor’s office in about 15-30 minutes. You don’t need to do anything to prepare, but your doctor may ask you to stop taking certain medications a few days prior to the injection. You should also inform your doctor if you’ve had a Botox injection in the past four months, even if it wasn’t an injection for migraines.

During your appointment, your doctor may numb your skin with a topical anesthetic. You may receive several shots during the procedure in the areas on your head and neck where you feel pain. The shots may feel like a slight pinch. 

After the procedure, you’re welcome to go home immediately. It’s safe to drive yourself home, but you may want to bring someone along just in case.

Note: Injections should ONLY be given by a licensed health care provider who has been trained to administer Botox for migraine treatment. There is a high risk for complications when injections are performed by unlicensed or untrained individuals.

Side Effects of Botox for Migraines

Side effects are generally mild and will typically go away within a day or two. They may include:

• Headaches or sore neck
• Pain, swelling, or redness at the injection site
• Drooping eyelids or eyebrows
• Temporarily blurred vision
• Dry eyes or excessive tearing

Your doctor will discuss these side effects with you during your appointment, including what over-the-counter medications you can take to ease the discomfort.

More serious side effects are rare, but possible in patients with muscle or nerve conditions or breathing-related problems. For this reason, it’s important to see a board-licensed neurologist so that they can determine if Botox is a safe migraine treatment for you.

Schedule an Appointment Today

If you suffer from chronic migraines and haven’t found relief with other medications, Botox may be able to help you find relief. To learn more, schedule an appointment with a Florida Medical Clinic neurologist today!

Disclaimer: This blog is not intended to substitute professional medical advice. Always talk with your doctor before starting or stopping medications.

Does botox for migraines help wrinkles

• 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.

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

First: What exactly is a migraine?

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.