FDA approved Botox injections to treat chronic migraine in 2010. “Study results overall are mixed, but I’ve seen positive results,” says Sonia Lal, MD, assistant neurology professor at Loyola University Chicago, “when the number of treatments is adequate.”
According to a new analysis of data from the PREEMPT (Phase III Research Evaluating Migraine Prophylaxis Therapy) trials, published in 2010 and involving 1,384 adults with chronic migraine, among those who received Botox injections, about 70 percent reduced headache-days-per-month by at least half by study-end at week 56. Treatment success is typically defined as migraine frequency and/or severity reduction of at least 50 percent. Botox-maker Allergan sponsored the trials and analysis.
Botox is not a one-size-fits-all procedure, says Dr. Lal. Consider these factors when deciding whether it’s right for you.
How It Works
Botox is injected into 31 sites around the head in a five-to-10-minute procedure administered at a doctor’s office. Though the mechanism is not fully understood, Botox is thought to prevent certain chemicals from reaching nerve endings, thereby reducing migraine pain. Effectiveness emerges roughly one week post-injection, peaks around six weeks, and fades around three months. In small doses, Botox is not poisonous to the body.
It’s Not Used As A First-Line Treatment
Botox is not the go-to treatment for migraineurs. It’s usually considered after having had poor results with other migraine treatments (for example, at least two prescription medications, from two separate medication classes). Most insurance companies cover Botox treatments if two medications were tried, both for at least two months, without migraine improvement.
It’s For Chronic Migraine
Botox injections are FDA-approved to treat people who have migraines (lasting four-plus hours) at least 15 days each month.
One or two Botox treatments typically aren’t enough to assess responsiveness, says Dr. Lal. While some see improvements after one treatment, she says, patients often need at least three treatments, spaced three months apart.
When performed by an experienced doctor, Botox injections are generally safe. Still, mild side effects can occur. About nine percent of patients experience temporary neck pain, says Dr. Lal, about five percent, a post-procedure migraine. Other possible side effects include injection-site pain, and temporary swelling, redness, upset stomach, and rarely, drooping eyelids. Though highly unlikely, there’s a chance Botox may spread through the body and cause botulism symptoms. Pregnant or breast-feeding women should not use Botox.
Seek A Specialist
If, after consulting your doctor, you wish to explore Botox treatments, request a referral to a neurologist or headache specialist experienced with this procedure.
Would You consider Botox injections to treat chronic migraine? Why or why not?
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