BOTOX® Might be the Surprising Answer to Chronic Migraines
What Is a Migraine?
A migraine is an intense and painful type of headache. It can last from a few hours to several days. Migraines can also cause symptoms that are much more severe than those of a typical headache.
Diagnosing Migraine
An important part of treating migraine is getting the right diagnosis. That’s according to Jeremy Reed, MD, MPH, an ear, nose, and throat (ENT) specialist at UPMC Cole. As an ENT, he sees many sinusitis patients who get a concurrent diagnosis of migraines.
“A lot of sinusitis cases are actually chronic recurring migraines, so we tend to treat patients for sinusitis first, which often makes the migraines get better,” he says. “We do not see the same effect in the other direction.”
Dr. Reed says that it’s easy to confuse the two conditions because their signs and symptoms overlap. Bending forward can make both migraine pain and sinusitis headache pain worse. But a migraine can also present with pain in the forehead and around the eye — mimicking sinus pressure.
That’s why he recommends seeing a pain control specialist or neurologist for a full diagnosis if you’re having recurrent headaches.
Migraine symptoms
A migraine may cause moderate or severe pain in your head. Many describe this as pounding, throbbing pain. This may affect the whole head or can shift from one side of the head to the other.
Other signs of migraine usually accompany migraine pain, including:
- Blurred vision.
- Dizziness.
- Fever (rare).
- Fatigue.
- Loss of appetite.
- Nausea, vomiting, upset stomach, or abdominal pain.
- Paleness.
- Seeing bright flashing dots or lights, blind spots, wavy or jagged lines.
- Sensitivity to light, noise, or odors.
Acute migraines are those that have a 24- to 72-hour onset but go away after a few days. Chronic migraines are migraines that occur at least 15 days per month. Although migraines aren’t curable, they are treatable.
Common treatments include both over-the-counter and prescription medicine. However, if those types of treatment aren’t working well enough, you and your doctor might consider alternative treatments, including Botox® injections.
What Is BOTOX?
Botox is a prescription drug made of the bacterial toxin botulinum. It’s a common treatment for muscle conditions and for the appearance of wrinkles. It does this by temporarily paralyzing muscles in the face.
When you have a migraine, your body releases neurotransmitters and molecules that it associates with pain. Botox interferes with the transmission of these substances at the neuromuscular junction, where nerves and muscles meet.
We don’t really know why Botox works to relieve migraine pain. But injecting the drug into the face, head, and neck muscles makes it goes away. Researchers think that the nerves take up the drug and block pain-associated neurotransmission.
Treating Chronic Migraines with Botox
Botox temporarily slows muscle activity. Though it’s a common cosmetic option, Botox is also an effective treatment for treating a number of medical ailments. These include eye muscle conditions, overactive bladder, and excessive sweating.
In 2010, the U.S. Food and Drug Administration (FDA) approved Botox as a treatment option for chronic migraine.
BOTOX Treatment for Chronic Migraines
Botox can help reduce the occurrence of migraines and their symptoms in some chronic migraine sufferers.
Upon injection, Botox helps reduce the expression of certain pain pathways in nerve cells related to migraines and sensory systems. This differs from the other common use of Botox as a muscle relaxer.
What to expect from Botox treatment
Most people who choose to treat chronic migraines with Botox receive treatment about every two to three months. Initial treatment plans for Botox usually span two to three treatments, or six to nine months.
At each visit, your doctor will inject Botox into 15 sites on each side of the head and one in the front (for a total of 31 injections). The FDA-approved order and pattern for administering the injections are:
1. Your lower forehead, right above your nose. The procerus is the small muscle between your eyebrows and above your nose. It is the muscle you use when you’re angry and pull your eyebrows down into a scowl. Often, this is the first injection that your doctor will make during the treatment.
2. Your lower forehead, near the inside edge of each eyebrow. Above each of your eyebrows are the corrugator muscles. The doctor will inject these shallow muscles on each side of the face, close to the inside of your eyebrows. For safety, your doctor will inject upward, away from the eyelid.
3. Between your shoulders and neck on both sides. Your trapezius muscle is the big muscle that sits between your shoulders and your neck. The doctor injects three shots into your trapezius, visually dividing the muscle into three parts and injecting each one. They repeat this process on the other side, resulting in six total shots in the trapezius.
4. Between the back of your head, behind each ear. The occipitalis is the muscle on the back of each side of the head. It sits between the bony prominence (occipital protuberance) at the back of each ear and gets three injections per side. The first goes into the middle of the muscle, and the other two go above and to either side of the first injection, forming a V shape on each side.
5. The neck area. The cervical paraspinal muscle group in the neck region receives four injections, two on each side. The first goes just off the midline of the cervical spine below the bony prominence of the occipital bone. The second goes diagonally above that, toward the ear.
6. Your mid-forehead above each eye. The frontalis muscle lies under most of your forehead. This site gets two shots on each side, for four shots total, each near the top of the forehead.
7. Behind each temple above the ear. The temporalis is the muscle that covers your temples. Above the ear, your doctor will give you four injections on each side of the head for eight total injections. The first goes above your ear, with the second slightly above that. The third shot goes between those two positions vertically toward your temple, with the final injection behind the second one. They’ll then repeat this process on the opposite side.
“Botox injections are done as in-office procedures,” Dr. Reed says, usually taking about 15 to 20 minutes to give. Although the needles used are very thin and the injections are shallow, the injections can cause some discomfort.
Recovery is relatively quick, and many people return to work and social activities that same day, if not the very next day. Most people get migraine relief quickly.
Side Effects of Botox
As with any medication, side effects are possible with Botox. Side effects may include:
- Bruising or swelling around injection sites.
- Double vision.
- Dysphasia, or trouble swallowing.
- Eyelid droop.
- Flu-like symptoms.
- Muscle weakness.
- Neck pain or weakness.
Long-Term Effects of Botox for Migraines
Over time, some patients may develop antibodies to Botox, which may make it less effective. Relief from pain may also take longer.
If you’re considering Botox as a treatment for your chronic migraines, consult your doctor. Together, you can determine your best treatment options.
To learn more, visit the UPMC Headache Center website.
Editor's Note: This article was originally published on , and was last reviewed on .