Botox to treat migraines

Ayushi Chugh, MD, is a Neurologist at Banner Health Center in Peoria. Her office can be reached at (623) 876-3940.

Question: I have chronic migraines. Is it true that some physicians use Botox injection therapy for migraine prevention?

Answer: A migraine is a type of headache that can last from four to 72 hours. It may be associated with nausea or vomiting. Migraines are managed by a two-pronged approach. First, using rescue medications “as needed’ for pain relief. Second, using prophylactic medications, which are taken on a regular basis to reduce the frequency and severity of attacks.

If a person is experiencing chronic, intractable migraines with 15 or more headache days a month, lasting four hours or more and have failed to respond to at least 2-3 conventional preventive medications, Botox therapy may be considered.

An efficient way to categorize headache chronicity is by maintaining a headache diary. Tabulate the number of days in the past month that the person had any kind of headache pain (even the ones that did not require rescue medication or just an over-the-counter pill or herbal remedy was used or were troubled by migraine aura). Alternatively, subtract number of “headache-free” days every month from 31. If this number is more than 15, the person may be suffering from chronic migraines.

Botox (Onambotulinum Toxin A) is part of the group of drugs known as “biologics”- these medicines are made from living things. Botox neurotoxin is a purified protein that is made from a type of bacteria called Clostridium botulinum type A. It has many analgesic benefits, ranging from its effect on brain cells involved in pain transmission, to releasing nerve fibers under compression by an abnormally contracted muscle, as well as in improving blood flow.

Once you when you and your doctor have discussed the details of Botox therapy for chronic migraines, each regimen of 31 injections are given over seven key areas of the head, scalp, temple and neck, once every 12 weeks to prevent headache days. Committing to at least two treatment sessions is important to help decide if optimal effect can be obtained .The needles are small and patients often feel mild discomfort like tiny pinpricks.

The most common side effects of Botox include but not limited to local injection site pain, mild bleeding or neck pain. Rarely, slight or partial facial paralysis, eyelid drooping may be experienced. These injections take place in the doctor’s office on an outpatient basis and each treatment session takes no longer than a regular doctor visit.

To determine if Botox injection therapy would be suitable to you, discuss the treatment with your physician.