Botox for Chronic Migraine Relief: What You Need to Know

7 min read

Botox was approved in 2010 to treat chronic migraine. You may have chronic migraine if you have 15 or more headache days per month that last at least 4 hours for at least 3 months. Chronic migraine affects about 1% of the U.S. population and is three times more common in women.  

Migraines can interfere with daily living and can affect quality of life. People with migraine are more likely to miss work or school and are more likely to suffer from other conditions such as anxiety or depression. Studies have shown that Botox can reduce migraine days by up to 50%. Below you will find common questions about Botox and whether it is right for you.

Botox contains a neurotoxin made by Clostridium botulinum bacteria. It causes temporary paralysis of the muscle it is injected into. Botox prevents the release of acetylcholine. Acetylcholine is a neurotransmitter that relays messages from nerve cells throughout your body to the brain. This causes the muscles to be partially paralyzed and relaxed. When muscles are relaxed, this takes the pressure off of the nerves, relieving pain. 

The change in headache days over 1 year was studied. People in these studies were between the ages of 18 and 65, with the average age being 41. Of those, 90% were White and 86% were female. These people had an average of 20 headache days per month, with 19 of those days being migraine days. For the first 24 weeks, people received either Botox or a placebo. After week 24, all people received Botox. 

Another study looked at headache days over 2 years of treatment. People in these studies were between 18 and 73 years old, with an average age of 43. The majority were female (85%) and 81% were White. These people had an average of 22 headache days per month. All people in this study received Botox injections every 12 weeks. 

Results showed that Botox reduced headache and migraine days greater than placebo. People were able to take less acute migraine medicine since they were having fewer migraines. People also reported improvements in their quality of life due to fewer headaches and migraines. 

  • Fewer headache and migraine days per month: By week 24, people had about 8 fewer headache days per month. At week 56, people had about 12 fewer headache days per month.
  • Less time spent with headaches: At week 24, people had 120 fewer hours spent with headaches. By week 56, people had 169 fewer hours with headaches.

The longer-term study showed that Botox remained effective through 2 years of treatment. It reduced the number of headache days per month and reduced the impact of migraines on daily living.

Average headache days per month while using Botox:

  • Start of study: 22 headache days per month
  • Week 60: 13 headache days per month
  • Week 108: 11 headache days per month

Your results may be different than what was seen in the studies.

You may notice a reduction in headaches starting as early as 1 week after getting Botox. In studies, by week 3, the average number of headache days decreased by 1 to 2 days per week. Headaches continued to decrease throughout treatment. Some people may require two or three cycles of injections to determine if it works well and should be continued. Speak with your doctor if you have not noticed improvement within three treatment cycles. 

It takes a few weeks to kick in. You may notice that your forehead feels heavy, and you may not be able to move all of your facial muscles. This is due to the temporary paralysis of those muscles. 

You should notice improvements in headaches within the first several months, but it may take three cycles to see improvement.  Your doctor may ask you to track your headaches and migraines to see your progress. You can download a migraine tracker at www.botoxchronicmigraine.com. Speak with your doctor if you do not notice improvement within three cycles. 

Botox is only for adults over 18 who have been diagnosed with chronic migraine. It is usually for those who have not responded to oral preventative treatments, and it was not studied in people with other types of headaches or migraines. It is not known if Botox will help other types of headaches.

Botox is not recommended for people who are prone to muscle weakness. It can aggravate certain neuromuscular conditions like myasthenia gravis or amyotrophic lateral sclerosis (ALS)

The most common side effects of Botox for migraine are neck pain, muscle weakness, eyelid ptosis, and headaches. 

The good news is that side effects are temporary and should wear off before the next treatment cycle. In studies, side effects were more common with the first three injection cycles and decreased as cycles went on.  

Avoid lying down for 1 hour after injections. You should also avoid applying pressure to injection sites as this can affect the spread of Botox. Avoid massages or facials for at least 24 hours following Botox. If it spreads to other areas, it can cause eyelid drooping or uneven eyebrows. 

You should avoid OTC pain relievers and alcohol within 24 hours of your appointment. They can thin your blood and lead to bruising. 

Although rare, Botox can spread to other sites of the body. This can happen anywhere from hours to weeks after injection and could lead to botulism. Seek help right away if you experience any signs or symptoms of botulism. 

Symptoms of botulism include:

  • Trouble breathing
  • Trouble swallowing
  • Vision changes
  • Muscle weakness
  • Loss of bladder control
  • Loss of voice or voice changes
  • Slurred speech

Botox can weaken muscles that you use to breathe and swallow. Although rare, this can lead to death. Get help right away if you notice any issues with breathing or swallowing. Notify your doctor if you have a history of breathing or swallowing problems, as this increases your risk.

This is not a complete list of side effects of Botox. Talk to your doctor if side effects don’t go away or become bothersome. You can report side effects to the FDA at 800-FDA-1088. 

Botox will be injected by your doctor into seven head and neck muscles. Your doctor will inject 155 units into 31sites. It should take about 15 minutes. You will need injections every 12 weeks. 

The injection sites include:

  • Corrugator muscles, located just above the inner part of each eyebrow
  • Procerus muscle, located between your eyebrows
  • Frontalis muscle, located in your forehead
  • Temporalis muscle, located above the ears
  • Occipitalis muscles, located behind the ears
  • Cervical paraspinal muscles, located at the base of the skull, on each side of the spine
  • Trapezius muscles, located from the base of the neck to the shoulders on each side

Some medications may affect how Botox works or cause more side effects. Always tell your doctor about any medicines you take, including prescription, OTC, vitamins, supplements, and herbal medicines. 

Aminoglycoside antibiotics, such as gentamicin, neomycin, and tobramycin, should be avoided, as they can increase the effects of Botox. This can cause excessive muscle weakness or paralysis. 

Muscle relaxants can cause more muscle weakness when taken with Botox. Speak with your doctor for more information. 

Botox can increase the effect of anticholinergic medicines. This can cause an increase in unwanted side effects such as constipation, dry mouth, blurred vision, headache, and fast heartbeat. Anticholinergic medicines include antihistamines and medicines for Parkinson’s disease, overactive bladder, and stomach issues.

OTC pain medicine, blood thinners, antiplatelet medicines, and fish oil can thin the blood and may make bruising from injections worse. Avoid these medicines near treatment time if possible. 

If you take any of these medicines, speak with your doctor for guidance.

Botox wears off in about 10 to 12 weeks. You will need injections every 12 weeks. 

Rarely, your immune system can develop antibodies to Botox. These antibodies recognize Botox as a foreign substance and try to fight it off. These antibodies would decrease the effect of Botox. This is more likely to occur if you are receiving higher doses or the time between treatments is shorter than 12 weeks.  

Notify your doctor if you feel the injections are not working or if they wear off sooner than expected. 

Botox requires a prescription from a doctor. A headache specialist or neurologist can prescribe and give you the injections. Many medical spas or clinics offer Botox for migraine. However, it is best to see a specialist who is trained to treat migraines. 

Eligibility depends on your current prescription insurance coverage. Most insurances cover the cost of treatment. Some patients may still have out-of-pocket costs. There is a savings program that can help cover out-of-pocket costs. Visit www.botoxchronicmigraine.com/savings or call 800-442-6869 for more information. 

If you are without insurance or with limited coverage, contact myAbbVie Assist at 800-222-6885 or by visiting www.AbbVie.com/myAbbVieAssist.