Does Botox treat migraines and wrinkles at the same time?

Despite what you read, Botox cannot cure migraines.

A migraine headache is due to a vascular spasm deep in your skull. It is not reachable by Botox. Botox causes temporary paralysis of the muscles it is injected into. In proper hands, it is very safe and works very, very well.

Botox can be used to treat some types of tension headaches by paralyzing the muscles that are unnaturally tight causing the headaches.

Botox can help certain migraines and will paralyze the muscles which cause facial wrinkles.

Migraines which begin in the forehead or around the eyes respond to Botox the best. There is a sensory nerve which runs within a muscle deep to the eyebrow near the bridge of the nose. The theory is that muscle contraction irritates the nerve, which causes the migraines. Paralyzing the muscle prevents the nerve irritation and eliminates the cause of the migraines.

Unfortunately not every person will experience migraine relief as there are multiple causes of migraine but at least you still get the cosmetic benefits. I have many patients in my practice who return for migraine relief, not the cosmetic benefits.

When it works, this is one of the rare cases when you can have your cake and eat it too.

Headaches can have many origins including starting in nerves, muscle, and blood vessels.

Patients often note that their headaches are less frequent when they get Botox injections.

The injections for migraines are in areas where Botox is typically not used for wrinkle relaxation. If your primary goal is to treat the headaches then you must speak with a neurologist.

Treating migraine headaches with Botox can be a little tricky. Since we still don't know the exact mechanism of migraines, it is hard to say that Botox will always work.

Likewise, the location of the Botox injections to treat migraines is not always clear. Some patients can point to very specific points on their skull and say, "This is where I have my migraine pain." For other patients, the pain of a migraine may be more diffuse. Local injections of Botox into the specific area of pain may be very useful. If your pain is in your forehead, crows feet and glabella, then Botox injections might just do a great job with your wrinkles and your migraines! If your pain is more diffuse, then you might need to have the Botox injected over a broad area of your scalp.

I have had patients that get Botox treatment for their crow's feet, glabella and forehead who seem to get many fewer migraines even though their migraine pain is somewhere else on the scalp. This might be due to the fact that they can't move their facial muscles normally and such movement contributes to whatever triggers their migraines.

I don't think that the migraine relief with Botox is a systemic effect of Botox. I have patients with hyperhidrosis of the axilla (very sweaty armpits) and migraines. Their migraines do not get better even after getting 100 units of Botox injected into their armpits.

When treating chronic daily headache or migraines with Botox, most doctors will use a modified "Follow the Pain" approach.  Simply stated, that means if your migraines start out as tension in the middle of your forehead and between the eyes, then these are the areas that will receive some Botox. Treating these areas will also help upper face wrinkles. 

However, if your headaches normally start in the occipital area (back of the head) or temporal area (side of the head), then there may not be any clinical justification for putting Botox in those muscles of the upper face.

Due to the fact that these specific muscles (which cause the wrinkles in the upper face) are not being treated, you should not expect to see any improvement in those wrinkles.

Yes, this is true. Botox is a useful treatment for migraines in some patients. However, the important thing to remember is that the precise location of injections is different when it is being used for migraines and when it is being used cosmetically to reduce wrinkles.

In my practice, some people who get tension headaches have reported to me that their tension headaches are reduced after they have Botox cosmetic injections.

Botox does indeed treat migraine headaches. This is a lucky unintended side effect of the use of Botox for wrinkle treatments. Although one would have to inject at specific sites to treat migraines alone, Botox used for wrinkle reduction to the upper face will result in improved migraine control for those that are responders.

In my practice I still emphasize the cosmetic result and hope for a response in the migraine headaches. Because of the effect of Botox on local muscles one has to aim for maintaining facial symmetry.

I have treated a few patients with headaches but not specifically for migraines but more for tension. I did see slight improvement in their headaches and great improvement in their wrinkles.

When I treated these patients I specifically chose patients who had tension around the frontal areas. Botox will only work in the sites you injected. If you don't have tension in the areas of wrinkles then I don't think it will work.

I don't think it would be helpful for migraines because these work through a different mechanism, i.e. 5HT, which is certain receptor in the brain. People who suffer severe headaches however can suffer from mixed headaches which can be both tension and migraines. I would advise you to consult and be evaluated by the doctor, and that doctor should be able to determine whether it would perform both functions.

Hi Jeane,

Studies have found that patients treated with Botox have decreased frequency of their migraine headaches, as well as less severity if they do get the headache. By treating the brow muscles (corrugators) and adding a little Botox to the upper forehead, your wrinkles and headaches can be improved with the same treatment.

Good luck.

I have been treating myself with Botox for many, many years to prevent ocular migraines.

When I get migraines, I get "ocular" migraines. This means I have vision problems, loss of vision, and shooting lights when I get a migraine. I can always tell when the Botox is wearing off because my migraines come back.

I treat many patients for migraines with Botox and in most people, it is beneficial.

There are different places to inject when treating for migraines, as opposed to treating for wrinkles, but you can kill two birds with one stone.

I am one of the first doctors who reported that Botox can be effective in the treatment of migraine headache and I am probably the best known for this in the world. Unfortunately, I am also the first ever to be sued for this (I did win in court).

While many patients who experience migraine headaches have reported improvement following Botox treatment for wrinkles, the specific injection pattern for Botox migraine treatment is quite different than what we use for wrinkle reduction. While you may notice some improvement of your migraine pain and severity following Botox for wrinkle reduction, I would strongly advise that the injection pattern for migraines is very specific and should be followed by your doctor.

Botox is used off-label for migraine treatment with good results.