Botox injections for migraines have been proven to reduce the intensity and duration of migraines for those who suffer. Botox was developed in the 1970s by an ophthalmologist who was looking to develop a treatment for strabismus (crossed eyes). This simple migraine treatment was discovered accidentally when people undergoing plastic surgery also experienced migraine relief. While they don’t work for everyone, Botox injections for migraines offer another way to approach treatment of migraine headaches.

What are Botox injections for migraines?

Botox injections use onaboutlinumtoxin A, also known as the botulinum toxin, injected in small amounts to certain points in the head to treat migraine headaches, tension headaches, and chronic daily headaches. This treatment has been shown to be most effective for headaches that are located in the forehead and neck. Botox has also been used to treat the following conditions:

  • Focal limb dystonia (upper limb spasticity)
  • Muscle contractures
  • Lower back pain

How can Botox injections treat migraines?

Botox injections for migraines cause involuntary relaxation of the muscles by blocking muscle-contracting signals to nerves.

For tension headaches and other migraines related to tense nerves, this relaxation can be enough to relieve the pain. For muscle stress and tension that is a side effect of the headache itself, Botox injections for migraines can help relax this clenching and potentially help relieve the pain.

What can patients expect from Botox injections for migraines?

Receiving Botox injections for migraines is a straightforward outpatient procedure. The skin in the area to be injected is cleaned. Most injections are administered in the forehead area, usually above the eyes or where “worry lines” might occur. Because this area may be sensitive or patients may be experiencing hypersensitivity to pain, a topical anesthetic may be applied before the injection.

The doctor will inject Botox with a very thin needle. At least two injections are generally administered, but more may be performed if the area being treated is larger.

After receiving Botox injections for migraines, patients can immediately return to their normal schedule. Over-the-counter non-steroidal anti-inflammatory drugs may be taken for any pain or inflammation. A cold compress or ice may help with any swelling or bruising that may occur.

Pain-relieving effects last for approximately two to six months but may not occur immediately. Botox injections for migraines may be repeated every two to six months. For chronic migraine pain, multiple Botox injections may need to be administered before the effects are felt.

What are the side effects of Botox injections for migraines?

Although the dose of botulinum toxin is small, there are a few side effects of Botox injections for migraines, some of them potentially serious. 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 not considered serious (although they can be uncomfortable).

More serious side effects may develop in rare cases. The following should be immediately reported to a doctor:

  • Trouble speaking, breathing, or swallowing
  • Impaired vision
  • Bladder incontinence
  • Muscle weakness

For daily or chronic migraine sufferers, the more mild side effects and risk of serious ones may be worth the risk for relief.

Do Botox injections for migraines work?

If you are considering Botox injections for migraines, it is important to look at not only the potential side effects but also the potential benefits.

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, attacks they did experience were less intense, of shorter duration, and required less treatment than adults who did not receive Botox injections for migraine. These injections were also well-tolerated in adults experiencing migraine with and without aura.

Another study published in The Journal of Headache and Pain looked at the effectiveness of Botox injections for migraine with 254 adults. Their results were similar. Migraine attacks decreased and 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 Botox published in Neurology in April 2016 updated the recommended conditions that are successfully treated with Botox, including migraine headaches. These guidelines recommend Botox for chronic migraines but do not recommend them for episodic migraines or tension headaches.

Who should not receive Botox injections for migraines?

The side effects of Botox injections for migraines are well-known. The U.S. Food and Drug Administration 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.

Other than that, there don’t seem to be any specific groups of people or health conditions that are contraindicated for Botox 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 well.

As Botox injections for migraines are considered 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.

Have you ever received Botox injections for your chronic migraine headaches? If not, would you consider this treatment?

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