An Overview of Using Botox for Migraine Treatment

In 2010, the Food and Drug Administration (FDA) approved Botox (onabotulinumtoxinA) as a prescription medication treatment for people with chronic migraines. Using Botox for migraine treatment has proved beneficial for patients who experience 15 or more migraines a month, but using Botox doesn’t come without risk. Read more about using Botox for migraine treatment, including its benefits, and risks, from this overview.

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What Is Botox?

Botox is a botulinum neurotoxin, a poison that affects nerves, manufactured by a bacterium called Clostridium botulinum. This is the same type of bacteria that causes botulism, a progressive, potentially fatal infection that can lead to muscle paralysis, slurred speech, and droopy eyelids, among other symptoms. When this neurotoxin is delivered via injection, however, its effect is focused, and it isn’t dangerous. 

Chronic Migraine

Chronic migraine is diagnosed when you are experiencing 15 or more migraine and headache attacks per month for at least three months in a row. This condition is relatively rare, affecting only about 3% of all migraine patients.

In addition, Botox may be indicated for several other medical conditions:

  • Urinary incontinence (overactive bladder) due to multiple sclerosis (MS) or other neuromuscular conditions
  • Upper limb spasticity, in which arms and hands become tense and overactive
  • Primary axillary hyperhidrosis, characterized by excessive sweating in the palms, hands, and other parts of the body
  • Blepharospasm (an eye twitching disorder) and strabismus (crossed eyes)

How Is Botox Used for Chronic Migraine Treatment?

Essentially knocking out nerves, Botox is probably best known as a cosmetic treatment to smooth out facial wrinkles. For chronic migraine, injections of botulinum toxin target nerve endings associated with pain, blocking them from releasing chemicals that activate the brain’s pain network.

Typically, Botox injections are indicated when other treatments for chronic migraine—everything from medications to lifestyle changes—haven’t succeeded in managing it. These injections are delivered to seven specific locations on the forehead, temples, sides, and back of the head, as well as the neck.

The effects of Botox injections aren’t permanent, and additional treatments are recommended every 12 weeks. This means you’ll have to see your medical provider regularly throughout the course of this therapy. It may take several appointments before you see an effect, and you may still have to take prescription medications for the best effect.

Benefits of Botox

Since Botox was FDA approved for use in people with chronic migraine, it’s been shown to be successful against a condition that’s notoriously difficult to manage. Currently, the consensus in the medical field is that about 65% of patients see reductions in symptoms after three courses of injections.

This yields many benefits for migraine patients. A study published in The Journal of Headache Pain in 2018 noted that, when successful:

  • There was a significant reduction in the frequency and severity of headache pain.
  • Migraine medication usage significantly dropped.
  • Treatments were well-tolerated and effective over the long term (up to three years).    

Risks

While Botox injections are generally well-tolerated, there are risks to this therapy. As you undergo it, track how you’re feeling and never hesitate to contact your doctor is anything feels off. Seek emergency medical attention if you experience any of the following:

  • Loss of breathing ability
  • Difficulty speaking or articulating
  • Inability or difficulty swallowing

Several other adverse events may also arise with Botox treatment for chronic migraine:

  • Worsening of any existing neuromuscular disorders
  • Urinary retention
  • Infection of one or more of the injection sites

Side Effects

As with any treatment, there is a chance of side effects with Botox treatment. Since these are given as shots, for instance, there’s always the risk of pain or tenderness at injection sites. In addition, common side effects, found to occur in 9% or less of cases, are:

  • Neck pain
  • Headache or worsening migraine attacks
  • Drooping eyelid or changed facial expression
  • Pain at the injection site
  • Facial palsy (partial paralysis of the face)
  • Flu-like symptoms

Rarer side-effects are seen in 1% or less of cases and include:

  • Vertigo (dizziness)
  • Dry eye
  • Fluid retention causing puffiness and swelling of the eyelids
  • Difficulty swallowing
  • Eye infection
  • Jaw pain

When You Should Consider Using Botox for Migraine Treatment

Botox injections are not a first-line treatment and are only considered when other means of managing chronic migraine haven’t succeeded. Notably, this treatment is not indicated for acute migraine—when there are less than 15 attacks a month.

Though widely tolerated, some conditions and diseases can contraindicate (not advise) their use or warrant extra monitoring and caution. These are:

  • Allergy to Botox: Hypersensitivity to the botulinum toxin in Botox can lead to anaphylactic shock, characterized by swelling, breathing difficulties, nausea, vomiting, and skin rashes.
  • Neuromuscular disorders: Those with disorders affecting the junction between nerves and muscles, such as myasthenia gravis and Lambert-Eaton syndrome, are at a higher risk of adverse events, such as respiratory problems.
  • Infection at the injection site: If infection arises due to injections, treatment is discontinued.
  • Being pregnant or nursing: There hasn’t been adequate testing on the safety of Botox during pregnancy or when breastfeeding. It’s typically not recommended for this population.
  • Age: The safety of this treatment has not been determined for children under the age of 18, so this treatment is typically avoided.
  • Respiratory problems: A history of respiratory issues might also warrant cautious use as Botox can affect lung function.  

Other Ways to Manage Chronic Migraines

Since there is no cure for chronic migraine, taking on this disorder requires a multifaceted approach, of which Botox injections are just a part. Approaches generally tried prior to Botox include:

  • Lifestyle adjustments: Losing weight and managing obesity, ensuring adequate and consistent sleeping patterns, exercising, and minimizing stress can all help prevent migraine attacks. In addition, you’ll need to stay hydrated and steer clear of migraine triggers, such as bright lights, loud sounds, red wine, cured meats, and certain cheeses.  
  • Stopping certain medications: A common cause of chronic migraines is the overuse of medications used to treat pain and headache, which can actually make matters worse. Use of nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen, like Advil and Motrin, and others), opioid drugs (Vicodin and oxycodone), and barbiturates (Amytal and Butisol) may have to be stopped.  
  • Taking medications: Medications can come in various forms. The two main categories of medications are abortives and preventives.

Abortive vs. Preventive Medications

  • Abortives are medications used at the time of a migraine attack, and can include triptans, NSAIDs, and newer CGRP inhibitors that are specific for migraine.
  • Preventive medications are used on a regular basis to help prevent migraine attacks from even happening. There are a number of medications in this group, including the newest CGRP inhibitors that are specifically designed for migraine. Older ones include Botox and anti-seizure and antidepressants that can be used to help prevent migraine attacks.
  • Transcranial/nerve stimulation: For difficult cases, some therapies aim to stimulate the cranial nerves to scramble and stop pain messaging. With transcranial magnetic stimulation (TMS), magnetic waves are delivered through the skin to specific bundles of nerves near the head and temple. Similarly, electrical stimulation can be delivered at home using special devices. 
  • Behavioral therapy treatments: Cognitive behavioral therapy (CBT) and other therapies promoting relaxation and managing chronic pain have also been shown to help alongside other treatment methods.
  • Alternative medicine: There’s evidence that regular acupuncture treatment, the use of needles to stimulate nerves, can also help reduce the frequency of migraine attacks. Acupuncture is be paired with other approaches. 

Even as you’re having Botox injections, you’ll likely need to keep up with other methods of managing the condition. Furthermore, it’s important to monitor your own progress.

A Word From Verywell

Among a growing number of treatment options for chronic migraine, Botox injections have proven effective in reducing the intensity and frequency of headache attacks. Though not without some drawbacks and a few risks, Botox helps manage some of the most painful characteristics of this debilitating condition. Talk to your doctor to see if Botox injection could be a good option for you.  

Frequently Asked Questions

  • Exactly how many Botox injections will I need for migraine treatment?

    Individual cases vary, but effects are felt as soon as two to three weeks after treatments. Most see an improvement within the first three treatments.

  • How long does Botox for migraine treatment last?

    The effects of treatment usually last about 10–12 weeks, which is why Botox therapy requires multiple appointments.

  • Where do clinicians inject Botox for migraines?

    A typical treatment entails 30–40 injections. These are targeted in 17 specific locations on the forehead, temples, sides of the head, back of the head, as well as the back of the neck.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Rizzoli P. Does Botox reduce the frequency of chronic migraine?. Updated September 18, 2019.

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