Migraines and headaches are conditions characterized by pain and discomfort in the head, but they have distinct differences. Headaches refer to any pain felt in the head or upper neck, and they can be classified as primary or secondary, depending on the underlying cause. Primary headaches, like tension headaches and cluster headaches, are not caused by an underlying condition, while secondary headaches are symptoms of an underlying issue. Migraines, on the other hand, are a specific type of headache known for recurring moderate to severe pain, often accompanied by additional symptoms such as nausea, vomiting, and sensitivity to light and sound. Migraines are considered a neurological disorder and can significantly impact daily life. Consulting a healthcare professional is important for proper diagnosis and management of migraines and headaches.
Botulinum toxin, better known as Botox®, is most commonly used for cosmetic purposes, but it also has many other clinical uses, including as a treatment for migraines. Botox was FDA-approved as a migraine treatment over a decade ago, and since then it has provided relief for thousands of migraine sufferers.
Botox is a toxin that works by blocking the neurotransmitters that tell your muscles to contract. When used in small doses, it can paralyze the muscles that contribute to or worsen migraine headaches.
Botox for migraines is a simple outpatient procedure. With the patient seated in a chair, the practitioner will inject up to five units of Botox at various locations, including the forehead, the sides and back of the head and the back of the neck. The procedure may be modified based on the patient’s needs, depending on where migraines usually occur.
Botox treatments are typically given every 12 weeks. Patients will usually decide between the second and third sessions whether Botox is beneficial enough to continue treatments, but the majority of patients will see a substantial decrease in both frequency and severity of migraine headaches while undergoing Botox treatments.
Patients using Botox can usually stop other preventive migraine medications, such as calcitonin gene-related peptide (CGRP) inhibitors, but will want to continue to have an abortive medication on hand in the event of a migraine attack. These include over-the-counter and prescription non-steroidal anti-inflammatory drugs (NSAIDs), triptan medications such as Maxalt, Relpax or Imitrex, and some abortive CGRP inhibitors such as Ubrelvy and Nurtec.
Botox is well tolerated by most people but there are some possible side effects, including redness or soreness at the injection site, drooping eyelids and neck pain. These are all usually mild and temporary. Serious side effects such as muscle weakness, blurry vision or trouble swallowing are extremely rare, but you should discuss with your provider if you have concerns.