A migraine is more than a headache: Migraine is a neurological disease characterized by severe head pain (often on one side) and symptoms such as nausea or vomiting and sensitivity to light, sounds, and smells.
If you experience a headache at least 15 days out of the month — with at least eight of those days meeting the criteria for migraine — for more than 3 months, your doctor may diagnose you with chronic migraine, which impacts around 3 to 5 percent of the U.S. population.
One treatment you may have never considered is botulinum toxin — specifically, onabotulinumtoxinA (Botox). That’s right: The same substance that’s used to smooth fine lines and wrinkles can also treat chronic migraine. Here’s everything you need to know, including how it works and whether the injections may be right for you.
How Botox Works to Treat Chronic Migraine
5 Essential Facts About Botox for Chronic Migraine
1. There are several brand names of botulinum toxin injection, but the Food and Drug Administration (FDA) has only approved Botox for preventing chronic migraine.
The FDA approved Botox in 2010 for the prevention of chronic migraine in people age 18 or older. “There are other botulinum toxins available, but they haven’t been studied for migraine,” says Andrew Michael Blumenfeld, MD, director of the Headache Center of Southern California.
2. Getting Botox injections for chronic migraine may hurt a little, but the procedure takes only a few minutes and can be done in your doctor’s office.
Getting poked with a needle is never fun, but rest assured, the needle is small, similar to an acupuncture needle. And the injections are superficial, so they shouldn’t hurt too much, says Dr. Blumenfeld. Patients typically receive a total of 31 injections every 12 weeks, which may sound like a lot, but a skilled practitioner should be able to administer them quickly, in five minutes or less. “The patient is seated in a chair, and I talk to them during the procedure to keep them relaxed,” says Blumenfeld. “The forehead and head injections may hurt a little, but the neck and shoulder ones are hardly anything but a little pinch.”
3. The injections can take weeks or months to work, and you may need to get the procedure done multiple times to experience relief.
Botox injections can help decrease the frequency and severity of migraine. One review, published in June 2018 in the Cochrane Database of Systematic Reviews, found that botulinum toxin type A may reduce the number of migraine days by two per month. Still, the injections aren’t a quick fix. It can take weeks or months and multiple treatments to notice an improvement in your symptoms.
“Most people see a sequential improvement over time, meaning the second treatment is more effective than the first, and so on,” says Blumenfeld. “The more severe your migraines are, the more treatments you might need.” For example, he says, the intensity of your migraines could decrease from a 10 on the pain scale to about a 5; if you want better results, in this case you’ll need additional injections. For some people, Botox may resolve migraine completely, but it may take a few years.
4. Botox for chronic migraine seems to be safe, but there can be some side effects.
When given by an experienced practitioner, Botox injections for chronic migraine appear to be safe, with no known long-term side effects, says Emad Estemalik, MD, section head for headache and facial pain at the Center for Neurological Restoration at Cleveland Clinic. That said, there can be short-term side effects. “The most common one I hear is neck discomfort and weakness,” says Dr. Estemalik. “You may also experience a headache immediately after the procedure, but it usually subsides in a few days or weeks, as the treatment kicks in.” Other side effects may include pain, swelling, or bruising where the drug was injected; flu-like symptoms; watery or dry eyes; drooping of one eyelid or eyebrow; and drooling.
If you’re pregnant or nursing, you should avoid Botox injections, but they can be administered in dire circumstances. “I’ve done them when the migraines get worse and threaten the pregnancy,” says Blumenfeld. “But ordinarily, I don’t give them during pregnancy.”
5. Your insurance should cover the injections, but it depends on a few factors.
Because the FDA approved Botox for the treatment of chronic migraine, most insurance carriers, including Medicare and Medicaid, will cover the treatment. But they may require you to try at least two or three other preventive medications before covering the injections, says Estemalik. Once you’ve tried other drugs that either didn’t work or had intolerable side effects, your insurance carrier should cover Botox for chronic migraine prevention, he says.
Even if your insurance provider covers Botox, you’ll still be responsible for any copays or deductibles. If you don’t have insurance, the list price of the medication is more than $1,200, plus whatever your provider charges to do the procedure.
5 FAQs About Botox for Chronic Migraine, Answered
Who Is a Candidate for Botox?
Next Steps: Making Migraine Treatment Decisions
Before your next doctor’s appointment, ask yourself the following questions.
- Are my current migraine medications working??
- Have my symptoms improved or gotten worse since my last doctor’s appointment?
- Is chronic migraine interfering with my quality of life??
- Am I willing to get shots if it means migraine relief??
- Do I trust my doctor to perform the procedure??
- Does my insurance cover Botox injections?
Keep these questions on hand to ask at your next doctor’s appointment.
- Am I a good candidate for Botox?
- Are there any other medications I should try before getting Botox for my chronic migraine?
- Is there anything else I can do to ease my symptoms?
- If I try Botox injections, how quickly will I experience relief??
- How long will the relief last??
- Are there any medications or supplements that can interfere with this treatment??
- What happens if the injections don’t work for me?