Botox for Chronic Migraines. Does It Help?

The severe throbbing of a migraine can strike suddenly and debilitate quickly, and last for hours or even days. People who suffer from chronic migraines may have sought relief using over-the-counter (OTC) medications and by trying to avoid triggers, but what if migraines have become more frequent or severe? Is there anything else to consider trying?

Key takeaways:
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    Chronic migraine headaches affect from 1% to 2% of Americans.
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    Treatment options include over-the-counter and prescription medications.
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    Few treatments are available to prevent chronic migraines.
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    Botox was approved by the FDA in 2010 to reduce the frequency of migraines.
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    The botulinum toxin is injected near specific nerve endings to interrupt pain signals.
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    Injections are administered every three months in specific sites on the face, neck, temples, and back of the head.

Nearly 30 million Americans suffer from migraine headaches, women more frequently than men. Approximately 10–12% of the population has migraine headaches, and 1–2% have chronic migraines 15 or more days per month. In this article, we will discuss whether Botox injections can help with migraines and who should consider this type of treatment.

What causes migraine headaches?

Migraine headaches are caused by inflammation in the brain which makes blood vessels to swell and increases pressure on the nerves. People may have various triggers which can cause migraines, including the following:

  • Sleep deprivation/surplus;
  • Skipping meals;
  • Bright lights, loud noises, strong odors;
  • Stress;
  • Weather changes;
  • Alcohol and certain food additives.

Available migraine treatments

Although there is no cure for migraine headaches, treatments to stop a migraine in progress are available. These include over-the-counter anti-inflammatories, such as acetaminophen or ibuprofen, or prescription drugs like triptans, which block pain signals and constrict blood vessels. Ergotamine-containing drugs may also be prescribed with caffeine to prevent blood vessels from expanding.

To prevent future migraines, options include the following:

  • Anti-epileptics;
  • Anti-depressants;
  • Beta-blockers;
  • Calcium channel blockers.

Doctors also recommend trying to identify your triggers and avoiding them if possible. Finally, biofeedback may help you detect and respond to subtle changes in your body’s response to anxiety, such as an elevated heart rate and blood pressure, which can help avoid triggering a migraine.

If nothing helps, there's also an option to perform a nerve decompression surgery, also known as the migraine surgery. Another available treatment method for people who have chronic migraines (appearing more than 15 days per month) is Botox injections.

“It is important to talk over treatment options,” says Rashmin Noushad who completed a fellowship in medical cosmetology and has administered Botox for cosmetic purposes. “I was unaware that Botox was also approved for my patients who have chronic migraines.” Newer therapeutics, such as monoclonal antibodies, may also provide relief.

What is Botox?

You may be familiar with Botox injections (onabotulinum toxin A) to reduce wrinkles, but Botox was approved by the FDA in 2010 for treating chronic migraine in adults aged 18 or older. The botulinum toxin in Botox is a neurotoxin produced by the bacteria that causes botulism. This toxin causes weakness or paralysis of the muscles which shape the eyes, mouth, and throat.

In tiny medical doses, Botox can provide relief from pain when it is injected into the space between nerve synapses. When taken up by nociceptors, the nerves involved in warning us of heat and pressure, the toxin appears to reduce activation of these pain pathways.

Botox effectiveness for pain relief

In randomized clinical trials, the number of headache days in a month were reduced in the Botox group by 9.0 days compared to 6.7 days in the placebo group. A meta-analysis of 44 studies published over 10 years found that real-world effectiveness seems to match what was seen in the clinical trials, but that effectiveness may wane over time. In a long-term study of Botox treatment on 132 patients who used Botox for a year, only 14 dropped out after one year due to lack of response (in 10 patients) or no further migraines (in 4 patients).

Side effects of Botox injections

The safety profile of Botox is good, but there are a few side effects identified in clinical trials, including neck pain, muscle pain, worsening migraines, and blurred vision. In randomized trials, adverse events were noted in the treatment group (3.5%) and the placebo group (1.4%). For people with chronic migraine, generally, the relief from migraine outweighs the adverse events.

Are Botox injections covered by insurance?

Migraines often strike women in particular during the most demanding years of life between ages 20–45. The economic costs to a family and society due to lost days of work and the ability to participate in daily activities are significant. For these reasons, an economic analysis of treatments for migraine found that Botox is cost-effective. Insurance, including Medicare and Medicaid, should pay for treatment but may have certain requirements, such as trying two other preventive therapies first.

Identifying triggers and adding complementary practices such as yoga and meditation, as well as learning biofeedback techniques to manage the body’s response to anxiety and stress, may help manage migraines when medication wanes or fails. Above all, know that you are not alone in dealing with this challenge, and your doctor can help you sort through the latest advances in treatment options to help you manage.

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