Migraine headaches are a serious pain condition that affects an estimated 39 million people in the U.S. The tricky thing with treating migraine headaches is that each headache can be as different as the person experiencing it. Many people become frustrated with medical interventions that cause serious side effects without much benefit. Botulinum for migraines can be an excellent treatment option for the refractory, stubborn symptoms of both acute and chronic migraines. Here are answers to some of the most frequently asked questions about Botulinum for migraines.
1. What are Botulinum injections for migraines?
Botulinum for migraines is a minimally invasive treatment option that helps to alleviate symptoms and reduce the frequency of chronic migraines.
Botulinum injections use onabotulinumtoxin A, also known as the botulinum toxin. They can be injected in small amounts to certain points in the head to treat:
- Tension headaches
- Chronic daily headaches
- Facial pain
Botulinum toxin is the same substance that can cause potentially fatal food poisoning in improperly preserved foods. However, in small precise amounts delivered by injection, it offers profound relief to migraine sufferers. Originally developed in the 1970s to treat strabismus (lazy eye) and blepharospasm (uncontrollable blinking), Jean and Alastair Carruthers discovered that some patients who were injected with cosmetic Botulinum experienced relief from migraine symptoms that had been unresponsive for years.
Botulinum can also help manage the following conditions:
- Focal limb dystonia (upper limb spasticity)
- Excessive sweating (hyperhidrosis)
- Overactive bladder
- Muscle contractures
- Lower back pain
2. How does Botulinum work for migraines?
Botulinum injections for migraines cause an involuntary relaxation of the muscles by reducing muscle contractions. It inhibits the release of acetylcholine, the neurotransmitter that causes muscles to contract.
For tension headaches and other migraines related to tense nerves, this relaxation can be enough to relieve pain. In headaches that come with muscle stress and tension as a side effect of the headache itself, Botulinum injections for migraines can help relax this clenching and potentially help relieve the pain.
3. What’s the research behind Botulinum injections for migraines?
If you are considering Botulinum injections for migraines, it is important to look at not only the potential side effects (see below) but also the benefits.
Research into the effectiveness of Botulinum for migraines in relieving the frequency of headache and its duration is strong. A double-blind study in 2020 found that this treatment was effective at reducing the frequency of migraine headaches for adults without serious adverse side effects.
In 2019, a meta-analysis of 17 studies found statistically significant evidence that Botulinum for migraines reduced the frequency of migraine and increased the quality of life.
This updated research contributes substantially to an already-large body of evidence.
Emerging research in 2018 also found long-term effects of Botulinum for migraines in terms of decreasing headache frequency. Patients in this study entered with an average of 22 headache days per month. When they left, that number dropped at 60 and 108 weeks by 9.2 and 10.7 days, respectively.
Another study that same year found that Botulinum for migraines was effective at reducing frequency and intensity of migraines over the course of three years for the majority of patients.
In a double-blind study of 123 adults with regular, chronic migraine, the adults receiving botulinum toxin type A experienced fewer migraine attacks each month. In addition, the attacks they did experience were less intense, of shorter duration, and required less treatment than adults who received a placebo. Adults experiencing migraine with and without aura tolerated these injections, too.
Another study published in The Journal of Headache and Pain looked at the effectiveness of Botulinum injections for migraine with 254 adults. Their results were similar. Migraine attacks decreased. Those attacks that did occur were over more quickly with less intense migraine symptoms (including less vomiting associated with the migraine).
Finally, new administering guidelines for Botulinum published in Neurology in 2016 updated the recommended conditions that are successfully treated with Botulinum, including migraine headaches. These guidelines recommend Botulinum for chronic migraines but do not recommend them for episodic migraines or tension headaches.
The vast majority of research indicates that Botulinum for migraines is effective in treating duration and frequency in both the short- and long-term, with few or no serious side effects. With the cost of migraines soaring to 14 billion per year and an abundance of evidence as to its effectiveness, it has the potential to provide relief from both the pain in your head and your wallet.
4. Who can get Botulinum for migraines?
The U.S Food and Drug Administration (FDA) currently approves Botulinum for migraines if the migraines are chronic and occur 15 days or more a month. Botulinum shots for migraines in children and adolescents may be effective but are not currently approved. In this case, insurance may not cover this procedure.
This treatment seems to be most effective at relieving the pain of a specific type of migraine. If your migraine headache feels like a tight band squeezing your head, Botulinum injections for migraines may provide significant relief. Botulinum is not as effective for other types of migraines, specifically those that feel like the pressure and pain are expanding outward.
This treatment is also most effective for headaches that are located in the forehead and neck. This corresponds with the most common injection sites (see below).
Other than that, there don’t seem to be any specific groups of people or health conditions that are contraindicated for Botulinum injections. As with all treatments, general health guidelines apply. People with a healthy body-mass index who are non-smokers, moderate or non-drinkers, and physically active will nearly always tolerate any type of medical treatment better.
The side effects of Botulinum injections for migraines are well-known. The FDA issued a black box warning in 2009 when the effects of the injections spread farther than the injection site, resulting in paralysis. This paralysis affected mainly children with cerebral palsy.
As Botulinum injections for migraines are a low-risk, minimally-invasive treatment, other warnings about pre-existing conditions and drug interactions may not apply. It is best to talk to your doctor about any concerns you have before undergoing this treatment.
5. Where do they inject Botulinum for migraines?
Most injections are administered in the forehead area, usually above the eyes or where “worry lines” might occur. Some patients find relief from injections administered directly into the scalp or neck, but everyone’s treatment might be slightly different.
In general, injections are administered on both sides of the head. You may receive more shots on the side where your migraine pain is particularly intense.
Specific sites for injection include the following.
- The eyebrows: One on each towards the center, with one in between
- The upper forehead: Just below the hairline, two injections an inch or so above the eyebrows
- The side of the head: Behind the temple and just above the ear on either side
- Back of the head: On the back of the head in line with the ears
- At the base of the skull: In a V-formation, two shots that narrow to the base of the skull
- Tops of the shoulders: Symmetrical injections into the trapezius muscle
The number and placement of Botulinum injections for migraine you receive depends on your specific treatment plan.
6. What can I expect?
Receiving Botulinum injections for migraines is a straightforward outpatient procedure. Your healthcare team will clean the injection area. If the injection site is sensitive or you have pain hypersensitivity, they can apply a topical anesthetic before the injection.
Your doctor will inject Botulinum with a very thin needle. Many patients find that the needle is so thin that the injection feels like a brief pinch. At least two injections are generally administered, but more may be performed if the treatment area is larger.
7. Are there any Botulinum for migraines side effects?
Although the dose of botulinum toxin is small, there are a few side effects of Botulinum injections for migraines. Some of them are potentially serious. Always talk to your doctor about your unique health risks.
Minor side effects may include:
- Burning sensations
- Bleeding and bruising at the site of injection
- Paresthesia (tingling) in the arms and legs
- Flu-like symptoms
- Blurry vision
- Temporary swelling
- Droopy eyelids
If droopy eyelids develop, patients may also experience tearing, dry eyes, crooked smile, welts, or itching. The eyebrows may also raise. These side effects are temporary and generally not serious (although they can be uncomfortable).
More serious side effects may develop in rare cases. Report the following immediately to your doctor:
- Trouble speaking, breathing, or swallowing
- Impaired vision
- Bladder incontinence
- Muscle weakness
For daily or chronic migraine sufferers, the mild side effects may be worth the risk for relief. Botulinum for migraines is generally well-tolerated, and the risk of side effects is small, especially when compared with the potential benefit.
8. What’s the Botulinum for migraines recovery time?
The recovery time for Botulinum injections for migraines is pretty much instantaneous. There is no downtime. The entire appointment, from signing in to driving away from the clinic, is usually less than an hour.
After receiving Botulinum injections for migraines, patients can immediately return to their normal schedule. There is no need to restrict activity or take any special precautions. If you experience pain or redness at the injection site, over-the-counter, non-steroidal anti-inflammatory drugs can help. In cases where bruising or swelling occurs, apply a cold compress or ice.
If you think you might be experiencing any adverse events, contact your doctor directly.
9. How long does Botulinum last for migraines?
Pain-relieving effects last for approximately two to six months but may not occur immediately. Botulinum injections for migraines may be repeated every two to six months. For chronic migraine pain, multiple Botulinum injections may need to be administered before the effects are felt.
The long-term effects of Botulinum for migraines may be less reliance on medications to prevent migraines. They may also offer a better quality of life. As research above indicates, the effectiveness of Botulinum for migraine may increase long-term.
10. Does insurance cover Botulinum for migraines?
The frustrating answer for this frequently asked question is that it depends. Not only does it depend on your insurance, but it also depends on your treatment plan thus far. Many insurance companies will cover Botulinum for migraines as a second- or third-line treatment. This means that your primary care physician or pain specialist will have to try other treatments before Botulinum injections for migraines are approved by your insurance.
Note that Medicare and Medicaid both pay for Botulinum injections for migraines, as it is an FDA- recommended treatment.
In general, the standard dosage is 155 units, with treatments costing between $300 and $400. Each treatment typically contains multiple units. Your insurance company customer service line can help you figure out if your particular plan covers some or all of this cost.
11. Where do you get this treatment?
Botulinum for migraines is typically administered by a specialist with experience in this protocol, like neurologists and otolaryngologists (ENTs). The key, though, is getting to their office. Working with a pain specialist is key. Often, you must work through other treatment options before you can be approved for Botulinum injections for migraines.
Pain specialists can help you get your life back with a comprehensive migraine treatment plan that includes identifying triggers, making lifestyle changes, and offering therapeutic options to reduce your pain severity, frequency, and duration.
If you still have questions about Botulinum for migraines, reach out to a pain specialist today. Find a pain specialist in Arizona or Texas by clicking the button below or look for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.