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Are you someone who has a chronic migraine1? Did you know Botox also helps in treating migraines? But how does Botox help migraines? This may be something new that you must be hearing.
What do you immediately think of when you hear the word “Botox2“? The answer is very clear. You may think of injections used to remove wrinkles or fine lines. And it is very true.
Botox does help to reduce or remove fine lines. But there is more to Botox injections that you must not be aware of. This article will discuss Botox and migraine attacks that may help you.
1. What is Botox?
Before we answer how Botox helps migraines, we must know what it is a Botox? Is it the name of the treatment? Or is it the name of the solution used in the injection? Well, it is both.
Botox is a neurotoxin derived from Clostridium botulinum 3bacteria found in nature in the soil, forests, lakes, and intestinal tracts of mammals and fish. This bacterium is responsible for releasing Botulinum toxin or Botox that causes Botulism, a type of food poisoning.
Naturally occurring C. botulinum bacteria and spores are harmless, but when these spores transform, and the cells increase in population, the problem arises.
Botox is a toxin, but it is very effective in small amounts. Botulinum toxin has a variety of preparations that doctors commercially use for treating different conditions. They include:
- Onabotulinumtoxin A (Botox)
- Abobotulinumtoxin A (Dysport)
- Incobotulinumtoxin A (Xeomin)
- Rimabotulinumtoxin B (Myobloc)
- Prabotulinumtoxin A (Jeuveau)
2. What is a Botox Treatment?
A Botox treatment is a type of treatment that uses a toxin called Botulinum toxin, which temporarily prevents a muscle from moving.
This toxin is produced by Clostridium botulinum which causes Botulism. Botox is a drug that is known for weakening or paralyzing muscles.
This treatment is used for treating a variety of conditions. But it is widely used for reducing fine lines and wrinkles around the eye.
In 1989, Botox was approved by the Food and Drug Administration to treat blepharospasm and other related eye muscle problems.
In 2002, FDA 4approved it as a cosmetic treatment for moderate to severe frown lines between the eyebrows. In 2013, Botox was approved as a treatment for wrinkles around the corners of the eyes by the FDA.
3. How does Botox work?
The procedure doesn’t take long. It usually takes ten minutes to inject Botulinum toxin into the target area.
The toxin powder is first diluted and injected directly into the target area. A very small needle is used, which causes little to no discomfort. The patient usually doesn’t need anaesthesia5.
You might wonder what Botulinum does: it can paralyze muscles for a while. For muscle contraction to occur, our neurons or nerve cells release a chemical called Acetylcholine at the junction where the nerve endings meet the muscle cells.
Acetylcholine then attaches to certain receptors on the muscle cells. This is how muscle contraction occurs. Botox prevents this neurotransmitter from being released from the axon endings at the neuromuscular junction (a junction where nerve endings meet muscle cells). Botox blocks signal from nerves to the muscles, thus causing flaccid paralysis.
4. What is Botox Done For?
Botox is done for a variety of reasons. They can be categorized under cosmetic purposes and medical uses.
Cosmetic purposes include:
- wrinkles around the eyes (crow’s feet)
- wrinkles between the eyebrows (also called frown lines, glabellar lines, or elevens)
- lines at the corners of the mouth
- horizontal lines on the forehead
- “cobblestone” skin on the chin
Botox is also done for various medical purposes, including:
- crossed eyes (also called Strabismus)
- eyelid spasms (blepharospasm) due to Dystonia6
- Cervical Dystonia (which is a neurological movement disorder that affects the head and causes neck pain)
- upper limb spasticity (recommended for anyone older than 2 years)
- preventing migraine pain signals in individuals whose migraine attacks last at least 4 hours in 15 or more days per month
- severe underarm sweating (also called Hyperhidrosis)
- reducing the symptoms of an overactive bladder
5. Are there any risks associated with Botox treatment?
While Botox is used for various reasons, it may have some side effects. Some of the risks that you might encounter after getting Botox injections are:
- dry eye (in cosmetic procedures)
- upset stomach
- spatial disorientation or double vision after treatment for Strabismus
- urinary problems after treatment of Urinary Incontinence
- corneal ulceration
6. What is a Migraine?
Now, that we know much about Botox treatment, let’s try to find out what a migraine is. Migraine is a headache, as everyone knows of it. But it is no normal headache you get when you watch television for a long time or the one you get after you work hours.
According to the American Migraine Foundation, a migraine may be referred to simply as a migraine. While headaches may cause other symptoms, such as autoimmune disease (such as headache or migraine), migraines generally occur separately.
A migraine is more or less a headache that leads to throbbing pain or a pulsing sensation. It usually occurs on one side of the head. It is followed by nausea and vomiting.
The person also becomes extremely sensitive to sound and light. Migraine attacks can last for hours or days together, causing severe pain.
7. Symptoms of Migraine
A migraine progresses through various stages, including the Prodrome stage, Aura stage, Attack stage, and Post-drome stage.
The Prodrome stage is the initial phase of a migraine. Also known as the “preheadache” or the premonitory phase, it signals that the headache is about to start. Migraine symptoms in this phase can be different from person to person, but the most common ones include:
- food cravings
- stiffness in the neck
- fluid retention
- increased rate of urination
- mood changes
- depression
- euphoria
- constipation
The aura phase in a migraine is distinct and won’t necessarily occur during every migraine attack. Symptoms in this stage can last 5 minutes and sometimes take as long as 60 minutes to disappear. People experiencing Aura generally have these symptoms:
- pins and needles sensations in an arm or a leg
- difficulty in speaking
- blurry vision
- vision loss
- the appearance of geometric patterns before the eyes
The Attack phase or the Headache phase is characterized by pain, usually on one or both sides of the head. This stage can last for hours or days together. Symptoms of this phase include:
- sensitivity to light, sound, smell, and touch
- nausea and vomiting
- throbbing pain on one or both sides of the head and neck
The Post-drome phase is also called the “migraine hangover.” Symptoms of post-drome include:
- fatigue
- lack of concentration
- body pain
- feeling drained
- sudden head movement
8. Various Treatments for Chronic Migraines
Migraine treatment aims to reduce headache symptoms and relieve the patient. Many options are available for patients to treat migraine. The treatment choice you will make depends on your headache’s severity.
Migraine treatments fall under two categories: pain-relieving medicines and preventative medications. Pain-relieving medicines are drugs taken to stop symptoms, whereas preventive medications are taken to reduce the severity of migraines.
8.1. Medications for providing relief
Medicines that can be taken to relieve pain come under this category. Some of the medications that are used for such purposes are:
- Triptans: This block pain transmission in the body. They can be taken as shots, pills, or nasal sprays and include prescription drugs such as Sumatriptan and Rizatriptan.
- Pain relievers include Aspirin or Ibuprofen, which are known to many patients. But when taken for a long period, these can lead to headaches, ulcers, or bleeding in the gastrointestinal tract.
- Lasmiditan: It is an oral tablet. It is approved for the treatment of migraine with or without Aura. These tablets can result in dizziness; therefore, it is advised that people intaking them do not drive or operate machinery for at least eight hours.
- Dihydroergotamine: It is available as a nasal spray or an injection. It can last longer than 24 hours. Thoswithve coronary artery disease, kidney/liver disease, or high blood pressure should avoid Dihydroergotamine.
- Ubrogepant: This oral medication relieves pain and other migraine symptoms, including nausea and vomiting.
- Opioid medications: These are recommended only for people who can’t take other migraine medications. They can prove to be highly addictive, which is why they are not recommended unless other drugs fail to relieve pain.
- Anti-nausea drugs: Anti-nausea drugs, as the name says so, prevent nausea and vomiting in individuals with a migraine.
8.2. Preventative medications
These medications can help lower the frequency of migraines occurring. Only people with severe migraine should use these. Some of these include:
8.2.1. Antidepressants:
An antidepressant called Amitriptyline can help prevent migraine attacks. These have a few side effects, such as sleepiness. Therefore, the doctor may prescribe other medications.
8.2.2. Anti-seizure Medications:
Valproate and topiramate are a few examples of anti-seizure drugs. These can have side effects such as dizziness, and weight changes, among others. These are not recommended for pregnant women.
8.2.3. Botox Injections:
Botox can be an effective way to treat chronic migraine. Injections of Botox are used every three months during treatment.
8.2.4. Blood Pressure-Lowering Medications:
A few examples are beta blockers (such as metoprolol tartrate) and calcium channel blockers (such as verapamil). They can also be useful for people with migraine.
It would help if you always took your doctor’s advice before taking any medications mentioned above. The healthcare professional will suggest the right medicine according to the severity of your migraine and also tell you the appropriate amount of medication to take.
These medicines can be harmful to you when taken in amounts more than recommended. Therefore, you should always consult a doctor before you go for any treatment.
9. How Does Botox Help Migraines?
In chronic migraine headaches, the symptoms occur for at least 15 days or more each month. If this is happening to you, you have chronic migraine. Migraines can be treated differently, one of which is to receive Botox.
In 2010, the FDA approved the use of Onabotulinumtoxin A as a treatment for chronic migraine. It is a safe and effective preventative therapy with rare side effects.
Botox injections block signals responsible for muscle contraction and hence help reduce migraine symptoms such as intense pain, nausea, vomiting, and sensitivity to light and sound.
It takes 10 to 14 days or longer for the symptoms to reduce. The first injections would be ineffective and won’t give as much relief as expected.
After a few treatments, you will gradually see the difference and experience relief from the excruciating pain. So, it would help if you were a little patient while doing this treatment.
There are various injection sites for getting Botox for migraine treatment. If you consider getting Botox, you might wonder where the toxin is injected into your body.
There are 31 injections (with 5 units per injection) used to inject Botulinum in different target sites in your body. Following are the injection sites for Botox treatment for chronic migraines:
- temples
- forehead
- upper back
- back of the head
- neck
- the upper bridge above the nose
Side Effects of Botox on Migraines
The chances of side effects of Botox treatment for chronic migraines are rare. Even if there are side effects, they usually disappear after a few days. Your healthcare professional will discuss the side effects before proceeding with the treatment.
If you experience severe side effects after Botox, you may have muscle and nerve problems or breathing issues. If you are someone who suffers from these conditions, you must take your healthcare provider’s advice on whether to receive Botox or not.
The most common side effects are neck problems and headaches. Your neck might have constant pain and stiffness to it after the procedure. Your muscles might weaken temporarily in the neck and upper shoulder. These issues resolve on their own after a few days.
If the toxin spreads to areas beyond the injection site, the following can occur:
- drooping eyelids
- sharply raised eyebrows
- vision changes
- difficulty in swallowing
- muscle weakness
10. Should One Get Botox for Migraines?
After talking in detail about Botox and migraine, the real question arises: whether you should get a Botox treatment for migraine or not. Well, it depends on you.
Botox is a safe and effective treatment for chronic migraine headaches. The FDA itself approves it. It is also a rapid process that requires 10 to 15 minutes.
The side effects of this treatment are little to none; even if there are any, they disappear after a few days. So, you don’t need to worry about the treatment’s major side effects. If you are someone who can tolerate minor discomfort after the procedure, you can go for it.
There are other medications and treatments too that can help treat chronic migraine. Other options, including prescription drugs and various therapies, should always be tried first.
If you have trouble taking medications prescribed by your doctor or find them to be useless, you can go for Botox treatment. Your medical professional would recommend Botox only when other options fail to ease or relieve your pain.
If your doctor gives it a yes, you should go for it. However, if you have breathing problems or muscle pain, you should consider talking to your headache specialist beforehand. This is because the side effects of the treatment include muscle pain too.
You won’t get relief from pain right away. The treatment needs some time to work. Results can take two to three weeks to show after a Botox fully.
Some people discontinue their treatment immediately, thinking the treatment is not effective. Hence, if you are not patient enough to wait for the treatment to work, Botox might not be the right choice for you.
Before getting the treatment, you must know a few things, including:
- Remember, Botox is an approved treatment only for patients who have chronic migraine (which means they get migraine attacks for at least 15 or more days in a month)
- It is recommended only for people above 18 years of age.
- You will get a total of 31 shots every 3 months.
The last thing you need to keep in mind is that Botox won’t cure your migraine completely. It is a procedure that can help reduce the pain you’re going through.
If you think this is your preventative therapy, go for it! It is not a cure-all. You would have to undergo this procedure every three months, and the results would be temporary.
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- Brin, Mitchell F., and Rami Burstein. “Botox (onabotulinumtoxinA) mechanism of action.” Medicine 102.S1 (2023): e32372. ↩︎
- Mungoven, Tiffani J., Luke A. Henderson, and Noemi Meylakh. “Chronic migraine pathophysiology and treatment: a review of current perspectives.” Frontiers in Pain Research 2 (2021): 705276. ↩︎
- Bhutani, Priyadeep, et al. “US FDA approved drugs from 2015–June 2020: a perspective.” Journal of Medicinal Chemistry 64.5 (2021): 2339-2381. ↩︎
- McGain, Forbes, et al. “Environmental sustainability in anaesthesia and critical care.” British Journal of Anaesthesia 125.5 (2020): 680-692. ↩︎
- Grütz, Karen, and Christine Klein. “Dystonia updates: definition, nomenclature, clinical classification, and etiology.” Journal of Neural Transmission 128 (2021): 395-404. ↩︎
Last Updated on by Sathi Chakraborty, MSc Biology
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