Botox for Migraines - Does It Work?

Botox has become a staple for migraine patients. Although a number of studies have come out showing benefits, and all of us performing the injections know the benefits, still, the use of Botox for migraines is off-label. When Reloxin comes out, the greater volume of distribution may be even more beneficial for patients with migraines than Botox.
Neurologic evaluation is always necessary before treating patients for migraines. You wouldn't want to treat a brain tumor with Botox!
The injections for migraines are in entirely different locations than conventional Botox for frown/crow's feet/forehead areas.

Botox can help to reduce how often you have migraines and how bad they are. It does interrupt pain signals between your brain and the nerve endings that connect to your muscles which ends up helping the migraines

We have known botox to work well for migraines for many years, and Botox was officially approved for use in migraines by the FDA in 2010. Officially, the FDA recommends injecting 155 units over 7 different sites within the head and neck. That's a lot of needles and a lot of botox! Recently we have developed more targeted techniques to apply smaller amounts of botox to fewer areas with less needles, resulting in the same (or even better) results.  In addition to Botox, which requires injections every 2-3 months, there are precision surgical techniques that can permanently reduce or remove migraines. These procedures are being performed at a few specialized centers around the world.

I'm sorry to hear you've been
suffering so long. As a migraine specialist, I have done significant research
into this field. BOTOX injections can provide relief for many migraine
sufferers because they disable the trigger muscles that contribute to the
headache. The only way to find out if there is a muscle component to your
headaches is to consult with a doctor who offers BOTOX for migraine treatment.
If it works for you, you may opt for a simple surgical procedure that provides the
same results as the BOTOX injections, but permanently. Although many people who
have migraines experience triggers from these certain muscles, some people have
other triggers and therefore aren't good candidates for BOTOX or the surgical
treatment. See a migraine specialist for an evaluation to determine whether you
are a candidate. You don't have to suffer anymore!

Botox injections use very fine guage needles so not very painful, certainly not afterwared. The average costs depends on the number of units injected and the area. Most of our patients find it both affordable and helpful for migraine headaches though not all patients benefit from them. But for those patients lucky enough to have a response - it can greatly improve your life.

Botox has been used successfully in patients with migraine headaches and tension headaches. I use this therapeutic modality frequently with success. Raffy Karamanoukian MD FACS

Botox is FDA approved for patients with chronic migraines age 18 and over.  Chronic means that you have greater than 15days per month of migraine headaches and each episode lasts greater than four hours. 

Certain patients have what is called a "peripheral trigger" for their headache pain.  A peripheral trigger is a site in the head and neck where the superficial nerves that give you feeling to the face and scalp get compressed or irritated.  When these nerves are irritated or compressed they send a pain signal to the area around the brain and cause your headache pain.

The way Botox works is to temporarily (3-4months) paraylze the muscles that irritate or compress these nerves; therefore to stop the pain signal before it begins.  However, not all nerve compression or irritation on these nerves in the head and neck is caused by muscle.  There are other structures that cause compression on these nerves that Botox does NOT work on.  In these select patients an outpatient (same day) surgical treatment is more effective to relieve their headache pain.

The surgical treatment of migraine headaches can be more than 90% successful at decreasing or eliminating headache pain at these peripheral trigger sites.  For more information please visit our website under "Headaches"

 

Treatment of migranes is a very individualized process.  The first step is to see a qualified plastic and reconstructive surgeon that can understand and guide you through the multiple surgical and nonsurgical options.  The patient must present with an active migrane.  Only migranes that are triggered by compression of peripheral nerves can be treated with botox, luckily at least in my practice this includes the majority.  A plastic surgeon with craniofacial experience can easily identify the possible locations of triggering and a diagnosis is made by stimulating and relaxing the muscles manually with special massage techniques or injecting a small amount of lidocaine near the triggering nerve.   If the migrane is treated, the diagnosis is made and options are reviewed.  The next step is to give the patient a trial of local muscular relaxation with botox administration which must not only significantly chemodenervate the local muscles, but also must be balanced through the face so as not to create an aesthetic deformity.  depending on level of relief, duration of relief and patient preferences, most patients opt for a permanent treatment without recurring cost.  The identified trigger nerve is decompressed in a quick in office surgical procedure and a small amount of fat is placed around the nerveto cushion and protect it from further irritation.   Patient staisfaction is very high with this protocol.  Remember there are many practitioners that will be willing to inject Botox for migranes who do not have the anatomical, physiological or surgical knowledge and experience to produce a result.  I strongly recommend seeing a plastic and reconstructive surgeon who can guide you.

All the best,

Rian A. Maercks M.D.

Numerous studies have shown Botox to be helpful for many patients with migraine.

Also, it is common for patients who get Botox for cosmetic reasons to remark that they suffer fewer headaches in the 3 or 4 months following Botox injections. 

The reasons why Botox is often helpful for headaches are not clear.

It is important that a person's chronic headaches are first evaluated and optimized by conventional methods by a physician who frequently sees headache patients.  After that,  many migraine patients find that giving Botox a try by an experienced specialist is well worth it.

Mark Lucarelli, MD, FACS

Madison, WI

Yes! Botox works for migraine headaches.  It was recently FDA approved and hopefully more insurance companies will start paying for these treatments.

Yes,  Botox has been proven to work for "chronic" migraine headaches.  It was recently FDA-approved for this.  Chronic migraines are those that regularly occur more than 14 days per month.  Of course, just like the cosmetic treatment, botox for migraines is not a permanent answer.  Follow-up treatments are necessary.