Botox For Chronic Migraines

Botox For Chronic Migraines

Botox is commonly used to reduce the appearance of wrinkles and fine lines that come with age. But, you should know that Botulinum toxin therapies have been proven helpful in clinical trials, and are therefore an FDA-approved remedy for chronic migraines. It’s possible that your doctor will suggest a change in medicine or way of life. Your doctor may recommend this treatment if he or she finds that you suffer from chronic migraines.

A Canadian ophthalmologist first used Botox on patients with strabismus (commonly known as crossed eyes) because he discovered that it helped relax muscles and stop persistent contractions. The medication stops muscular contraction by interfering with nerve signals. If you get persistent migraines, this is wonderful news, but if you wish to delay the physical indications of aging with Botox injections, this may be bad news.

Migraine headaches are a common occurrence. Most people don’t think much of their occasional headaches. But for about 10% of the population, headaches are so severe that they interfere with daily life. Migraines that persist over time can do more than just hurt. People who suffer from chronic migraines are frequently absent from work or school due to their condition. Read on to learn more on botox injections for migraines side effects/how to qualify for botox for migraines.

Botox For Chronic Migraines

Wrinkle-reducing treatments that use botulinum toxin injectables may also be used to treat chronic migraines. These treatments, known as neuromodulating drugs (such as Botox, Dysport, Xeomin and Mybloc), were approved by the U.S. Food and Drug Administration in 2010 for migraine treatment.

Plastic and reconstructive surgeon Sashank Reddy, M.D., Ph.D., explains how these drugs are a powerful treatment option for patients with chronic migraines.

WHAT YOU NEED TO KNOW

• The injectables used to treat migraines are the same kind used by aesthetic surgeons and dermatologists to minimize facial wrinkles.
• Licensed medical professionals treat migraines by injecting botulinum toxin into multiple areas around the head and neck.
• The treatments are approved for select people age 18 and older who experience 15 or more migraine days per month.
• It may take four weeks or more after treatment before you see a reduction in the frequency of your migraines, and more than one set of injections may be needed.

How do botulinum toxin injectables help treat migraines?

Researchers are eager to learn how botulinum toxin-based drugs help relieve migraine pain.  Evidence suggests that the drug interrupts the pathway of pain transmission between the brain (central nervous system) and nerves that extend from the spinal cord.

When you have a migraine, your body releases substances called neurotransmitters and molecules that are associated with pain. Botulinum toxin interferes with the transmission of these substances, typically where the nerves and muscles meet. Researchers think that when the drug is injected into the muscles around the face, head and neck, it is taken up by the nerves and interferes with pain-associated neurotransmission.

Why might I need botulinum toxin injections for migraine treatment?

Botulinum toxin treatments have been proved effective in clinical trials, and are one way to treat chronic migraines. Other medications, and lifestyle changes, might be recommended. If your doctor determines that you have chronic migraines, you might be a candidate for this treatment.

Sashank Reddy says, “Botulinum toxin injectables are part of a comprehensive suite of options that neurologists and headache specialists have for treatment of chronic migraines. While no single option is best for all cases, an approach that includes several different treatments can often reduce headache frequency and severity.”

Migraine Treatment with Injectables — What to Expect

Using a very small needle, a specialist injects botulinum toxin into the tiny muscles under your skin throughout various areas around your face, head and neck.

You might get injections in your forehead, temples, and the back of your head and neck. Sometimes the specialist will inject areas called “trigger points” where the headache pain originates.

“These treatments for chronic migraines should be individualized, respecting the unique anatomy and origin points of pain in each patient,” Reddy says.

It can take several weeks and multiple treatments before you start experiencing relief from your migraines. Some patients find they can discontinue injections without frequent migraines returning. Others need regular treatments to keep migraines under control.

“Injectables can be effective in reducing the frequency of headaches in patients with chronic migraine and can also reduce debilitating symptoms associated with these migraines,” says Reddy.

What are the risks of using injectables for migraines?

Botulinum toxin injectables should be avoided by pregnant women and nursing mothers, as well as people with an allergy to proteins in cow’s milk.

When given by an experienced and qualified health care specialist, botulinum toxin injections are relatively safe. However, some people experience pain, bruising or swelling where the drug was injected. Other possible side effects are:

• Headache or flulike symptoms
• Dry or watering eye
• Drooping on one eyelid, eyebrow or side of the mouth
• Drooling

Very rarely, if the toxin accidentally spreads into your body, other, more serious symptoms might occur over the course of hours or days. Call your doctor right away if you notice:

• Vision problems
• Muscle weakness
• Trouble speaking or swallowing
• Inability to control the bladder
• Difficulty breathing

How To Qualify For Botox For Migraines

The treatments are approved for select people age 18 and older who experience 15 or more migraine days per month. It may take four weeks or more after treatment before you see a reduction in the frequency of your migraines, and more than one set of injections may be needed.

What You Need to Know About Migraine and Botox

We’ve all heard of Botox, responsible for generations of smooth foreheads in Hollywood. But Botox has also brought relief to many people who suffer from chronic medical conditions. In 2010, Botox was approved for use with chronic migraine, and many patients are reporting success. What do you need to know before considering it?

What Type of Headache Responds Best to Botox?

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.

If you have been diagnosed with migraine and get migraine headaches often, you may wonder if there’s anything you can do to prevent them.

OnabotulinumtoxinA, or Botox, was approved in 2010 for adults who get chronic migraines. That means you have both:

• A history of migraine headaches
• Headaches (including tension-type) on most days (15 or more) of the month that last 4 hours a day or longer

It is not an approved treatment if you:

• Get headaches 14 or fewer days each month
• Have other types of headaches, like cluster

What Is Botox?

Botox is a neurotoxin, a poison made by bacteria called Clostridium botulinums. It can cause a deadly reaction called botulism if you eat it in spoiled food because it blocks signals from your nerves and paralyzes your muscles.

But it’s safe because the toxin isn’t digested in your stomach and the dose is much smaller amount than you’d get in spoiled food.

Doctors found that shots of Botox can help smooth wrinkles because it relaxes muscles in the face. It also helps people who have tics and spasms because of a nerve disease like cerebral palsy.

When people who had migraine headaches used Botox to treat their wrinkles, they told their doctors that their headaches were better. So doctors began to study it as a migraine pain treatment.

Does Botox Work for Migraine Headaches?

In a study of adults who get chronic migraine headaches, shots of Botox cut down the total number of days they had them or even other types of headaches. They also had more “crystal-clear” — pain-free — days each month, and they reported fewer days off work.

In another study, nearly half the people who took two rounds of Botox shots reported that the number of days they had a headache each month was cut in half. After five rounds of treatment, that increased to about 70% of the people.

Doctors think Botox works for migraine headaches because it blocks chemicals called neurotransmitters that carry pain signals from your brain. Botox is like a roadblock in that pathway. It stops the chemicals before they get to the nerve endings around your head and neck.

Botox Treatment

You’ll get several shots of Botox around your head and neck once every 12 weeks to dull or prevent migraine headaches.

You may need 30 to 40 shots in all, and you’ll get an equal number on each side of your head. If you have migraine pain in one particular spot, you may need more shots there. You could see results 2 to 3 weeks after your first treatment.

You should only get this type of Botox treatment from a doctor who’s trained to give these shots for chronic migraine headaches rather than for wrinkles or other cosmetic uses.

Side Effects

Neck pain and headache are the most common side effects for people who get chronic migraine headaches and use Botox.

It’s rare, but you can have an allergic reaction to Botox. Signs of this can be hives, shortness of breath, or swelling in your lower legs. Although there’s no confirmed case where Botox spread to other parts of the body, it is possible and could be deadly. The medication label includes this warning.

Botox Injections For Migraines Side Effects

When you think of Botox, you probably imagine cosmetic injections meant to smooth fine lines and wrinkles. While that is the primary use for Botox, it’s also become a popular treatment for chronic migraine.

If you have migraine attacks for 15 days or more every month, your doctor may have suggested Botox as a treatment. However, there are some side effects of Botox injections for migraine, including neck stiffness and muscle weakness. Other side effects are less common but can occur.

This article discusses possible side effects of Botox for treatment of chronic migraine.

What are the possible side effects of Botox?

Botox is well-tolerated by most people and is considered very safeTrusted Source if you go to an experienced practitioner. Still, there are some possible side effects that you should know about if you start using Botox to treat migraine.

Common side effects

Common side effects of Botox for migraine include:

• redness, soreness, or swelling at the injection site
• bruising
• chills
• fatigue
• dry mouth
• neck stiffness

A 2014 studyTrusted Source showed that neck pain was the most common side effect, affecting 4.3 percent of study participants. Injection site pain, drooping eyelids, and muscular weakness was reported in 2.1 percent of people.

In general, these side effects are simply the effect of injecting a foreign substance into your body. They typically go away after a day or two.

Longer-term side effects

However, there’s also the possibility of longer-term side effects. These may include:

• muscle weakness
• eyebrows that appear to “droop” or look uneven

These side effects are from the Botox treatment itself and may take several weeks to subside.

Serious side effects

In the studyTrusted Source noted above, serious side effects from Botox for migraine were uncommon, and were rarely severe enough for people to stop treatment.

However, there are cases when serious complications do occur from Botox. You should seek immediate medical help if you notice any of the following symptoms after your treatment:

• blurry vision
• swelling of your tongue or throat
• difficulty speaking or swallowing

How does Botox work in treating migraine?

Onabotulinumtoxin A, also known as Botox-A, was approved in 2010 by the FDA for the treatment of chronic migraine.

Botox is injected into specific areas of your head and neck involved in migraine pain. The effect lasts for about 3 months.

Botox injections were developed to block neurotransmitters that tell your muscles to contract. By blocking these signals between your body and your brain, Botox diminishes the appearance of wrinkles.

However, blocking neurotransmitters is also a way to prevent migraine attacks. Botox blocks the release of these chemicals from reaching your nerve endings and causing pain.

Migraine attacks are typically best treated right at the very beginning of an attack — but it can really difficult to do that.

If you try to treat a migraine with oral medication, you can end up taking too much of it. This can result in medication overuse headache and sometimes even trigger more migraine attacks.

Botox can work as a preventive treatment that keeps your brain from receiving the initial migraine signals, without the risk of “rebound headache” that comes with many oral medications.

If you’re thinking about Botox treatment for your migraine attacks, here are some questions you might consider and talk with your doctor about:

• Are your migraine attacks chronic? Chronic migraine is defined as taking place 15 days (or more), on average, out of every month. If your migraine attacks aren’t chronic, it’s unclear whether Botox would be helpful for you.
• Are you okay with multiple treatments? Botox might not be effective to treat migraine after your first treatment, and even when it works, it isn’t permanent. You’ll need to plan to get regular Botox treatments every 3 months if Botox becomes your long-term treatment plan.
• Will your insurance cover it? Your insurance may only cover Botox for migraine if you can document that you’ve already tried other treatments. Even then, you may have a hard time getting approval from some insurance providers. If you don’t have insurance, Botox can become costly, especially when you add up the cost of multiple treatments.

Who is not a good candidate for Botox treatment?

There are some people who should not get Botox for migraine attacks or for any other reason.

You aren’t a good candidate for Botox if any of the following apply to you:

• known sensitivity or allergy to botulinum toxin (or a history of botulism)
• signs of infection at or near the injection site
• neurological conditions that make you more prone to muscle weakness, such as amyotrophic lateral sclerosis (ALS) or myasthenia gravis
• you’re pregnant or breastfeeding.

How long does a Botox treatment take?

With an experienced provider, a Botox treatment will take about 20 minutes. Your first treatment might take a little longer to fill out paperwork and to speak with your provider about concerns and questions.

How many injections will I have to get?

More than you might think. If you’re getting Botox for migraine treatment, expect to get 30 or so injections, all in targeted areas in your forehead and neck. These areas are different than the targeted areas where you’d have Botox for a cosmetic treatment, like smoothing out your forehead.

How much does Botox hurt?

People with different pain tolerance (and different expectations) may answer this question differently. Botox needles hurt as much as any injection would, and the experience is over quickly. Be prepared for it to feel a little uncomfortable, and have an ice pack on hand to soothe inflammation or pain afterward.

How often will I have to get Botox for migraine?

Treatments are recommended once every 12 weeks. The effect of Botox may start to wear off before that, but getting the treatment more often than that is not recommended.