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MIGRAINE
AWARENESS CENTER

Botox for Migraines: What You Need To Know

Updated on September 28, 2022
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Maureen McNulty

Botox is perhaps the most recognizable brand of a medication called botulinum toxin. As a cosmetic treatment, Botox injections can reduce wrinkles on the skin. In addition, Botox is used to treat migraine headaches. Botox and similar drugs like Dysport, Mybloc, and Xeomin may help block pain signals in the head that cause migraines.

Along with other medications, lifestyle changes, and knowledge of migraine triggers, Botox may help lessen pain and improve the quality of life for people who live with migraine headaches.

Many members of MyMigraineTeam have discussed Botox. “I started Botox injections about four years ago,” wrote one member. “To say they saved my life is not an understatement.” Unfortunately, these treatments may not work for everyone.

What Is Botox?

Botox is a molecule extracted from a bacteria called Clostridium botulinum. Its full name is onabotulinumtoxinA or botulinum toxin. It usually acts as a toxic chemical, preventing muscles from moving normally. However, this effect may be helpful for people with migraines.

Botox is approved by the U.S. Food and Drug Administration (FDA) to treat migraines. It can be used by adults over the age of 18 who have chronic migraines (experience migraines at least 15 days per month).

People with more frequent migraines may see better results from Botox. Additionally, this option may be worth trying for those who haven’t seen much effect from other treatments, don’t like the side effects of their current treatments, or are likely to overuse pain medications.

How Does Botox Help?

Nerve cells connect all the different parts of your body with your brain and spinal cord. Your muscles, including the ones in your head and face, contain nerves that help them communicate with the brain. Once a migraine begins, these nerves produce chemicals called neurotransmitters that send pain signals to the brain.

Botox is injected near the migraine-producing nerves, blocking nerve endings in the muscle. This temporarily paralyzes the muscle and stops the tissues from creating pain signals, which helps prevent migraine symptoms such as head pain and auras (visual disturbances such as flashing lights).

What To Expect During a Botox Appointment

When it comes to treating chronic migraine, Botox is administered by general neurologists or headache specialists. Cosmetic Botox treatments from a dermatologist’s office or spa may not be as effective for headaches, as they have different targets.

During treatment, your health care provider injects Botox into your muscles with a very thin needle. General recommendations say to treat migraines with a set of 31 injections containing 155 units of Botox. These are spread out over seven areas of the head, face, and neck. However, in a survey, more than 3 out of 4 doctors in the U.S. said they use more than 155 units and modify the injection sites based on a person’s symptoms.

Overall, each appointment generally lasts about 20 minutes. The effects of these injections usually last about three months, after which they are generally repeated.

Botox and Migraines: How Well Does It Work?

Research has found that Botox for chronic migraine may help some people. In early clinical trials, this treatment didn’t lead to fewer numbers of headaches overall. However, people using Botox did experience fewer headache days per month and had a better quality of life. Later research has supported these results, showing that Botox treatments are safe and likely to work for many, but not all, people with migraines.

Some MyMigraineTeam members have experienced life-changing effects from Botox. “After being a chronic migraine sufferer for over 40 years, I can honestly say that this single particular treatment has given me my life back,” one member commented. Another reported, “This is the first time in my 54 years of life that I actually have a life and can plan things and do things without missing out.”

Botox doesn’t always eliminate migraines, but it may decrease their frequency. One member wrote, “I have had Botox for two years, and I went from having four to six migraines a week down to one or two a week.”

Many other members have seen small levels of improvements in overall wellness. “I’ve had three rounds of Botox,” one member said. “It does help reduce the intensity to where my migraine most days is just annoying versus putting me down and out.” “Botox does not take my headaches away but makes them maybe 10 percent to 15 percent better,” added another.

For some, Botox doesn’t help at all. “I had the injections and they did not work for me,” remarked one member. “I wanted them to work so badly. I tried again a year later and they just flat out did not work.” One member said, “Before injections, I was having on average 16 to 18 migraines a month. Now I’m having 24 to 26!”

How Long Does Botox Take To Start Working?

Some people need to go through multiple rounds of treatment before they notice an effect of Botox.

Many members have had this experience. “It took about three rounds before I was able to feel a difference. Yes, I still have migraines, but I was chronic for so long, that this feels like a gift. I function so much better,” wrote one member. “It took about three rounds to help any,” commented another. “After that, it was hit or miss, with some rounds helping more than others.”

Other members have had the opposite experience — they noticed an initial effect that seemed to taper off over time. “I was on Botox for a very long time,” a member shared. “It worked great at first, then it completely stopped.”

Is Botox Safe?

Common side effects of Botox injections include:

  • Pain or soreness
  • Swelling or bruising at the injection sites
  • Dry eyes, or eyes that tear up more often than usual
  • Drooping eyelids
  • An uneven smile
  • Drooping or sagging on one side of the face
  • Flu-like symptoms

MyMigraineTeam members experienced a wide range of pain while getting Botox. “It was one of the most painful experiences for me to endure! And I usually have a very high pain tolerance,” said a member. Another agreed: “My God, I’ve had four children, and it wasn’t as painful as these injections.” However, Botox was a much easier experience for some members. “Only three of the injections hurt very little,” wrote one person. “The others actually felt good!”

Many members have discussed their side effects. One reported, “I had minor side effects: slight headache lasting a few hours, spike headache for 20 minutes, queasy stomach, lightheadedness, and head pain with movement off and on for the first three weeks. Then all the side effects were gone.” “Sometimes, I end up with a migraine as a result of the injections,” another shared. “I find if I premedicate myself with my meds, I’m less apt to get one.”

Several members have experienced facial changes. “It messed up my eyebrows for a long time,” a member commented. “One was higher than the other, and it was extremely noticeable.” Another person experienced something similar: “I too can no longer arch my eyebrows like I used to, and my eyes are slightly droopy now, but I can cope with that downside at the moment.”

Changing the injection sites helps with facial symptoms, according to one member. “My first series of Botox shots made my eyelids puffy,” they said. “I told my neurologist and he changed to forehead injection spots. I’ve been fine since.”

Serious Side Effects

In some cases, Botox can cause more serious problems, including vision changes, speaking or swallowing difficulties, shortness of breath, or muscle weakness.

Some MyMigraineTeam members have talked about these effects. “Botox injections sort of worked initially, then the Botox migrated down to my eyes and I couldn’t open my eyelids,” said one member. “I would not take the chance of not being able to see for several days again.”

Another member had a similar experience: “I had Botox last year and ended up with blurry vision and more headaches for months until it wore off. My vision is better, but not back to what it was. I’ve actually had to get a new prescription for my glasses because the change is noticeable.”

“My dad had a side effect from the Botox,” commented one member. “He looked like a stroke patient. His whole left side was drooping, and you had a hard time understanding him.”

These side effects are rare, but make sure to tell your health care provider right away if you experience them.

Connecting With Others

MyMigraineTeam is the social network for people with migraines and their loved ones. On MyMigraineTeam, more than 78,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraines.

Have you tried Botox as a migraine treatment? Share your experience in the comments below, or start a conversation by posting on MyMigraineTeam.

    All updates must be accompanied by text or a picture.
    Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
    Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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