Can Botox reduce migraines?

Dr. Devi E. Nampiaparampil, MD
Pain Medicine Specialist

Botox may best be known as a wrinkle-treatment, but it can also relieve a migraine, says pain management expert Dr. Devi Nampiaparampil. To find out how Botox can be used to treat a migraine, watch this video.

Dr. Stuart A. Linder, MD
Plastic Surgeon

Botox is useful for reduction of migraine headaches. The recommended injection sites include: the corrugators, procerus, frontalis, temporalis, occipitalis, cervical paraspinalis and the trapezius muscles. The recommended retreatment is every 3 months. 

People who experience migraine pain who have had Botox wrinkle treatment reported a side effect: fewer headaches.

Botox appears to paralyze the muscles that might have a role in causing migraines. Some plastic surgeons are now offering Botox as a preventive treatment for migraines. However, after the facial muscles relax and the Botox has worn off, the migraines may return.

Botox can reduce migraines and is administered as a preventive or prophylactic measure. The person receives a set of 31 injections delivered every 12 weeks, which takes around 15 minutes each time. The majority of people who respond well report fewer migraine episodes each month, reduced pain intensity during the episode, and quicker recovery after an episode. For chronic sufferers, the treatment can reduce the number of headache days a month by up to 50 percent, which improves their quality of life significantly.

OnabotulinumtoxinA Injection (Botulinum Toxin Type A, Botox) is better known as a wrinkle-buster, since injecting tiny amounts above the eyes and over the bridge of the nose relaxes small areas of muscles, smoothing crow's feet and frown lines. But this toxin has more than just cosmetic applications—it's also approved for the treatment of cross-eye, abnormal squinting and eyelid twitching, neck and shoulder muscle spasms and severe sweating.

A number of anecdotal reports suggested people who got Botox injections to fight wrinkles also had fewer migraine headaches, spurring a flurry of clinical trials to test that idea. But the results have been disappointing. A review of 11 clinical trials concluded that Botox was "probably ineffective" as a treatment for episodic migraine and chronic tension headache.

However, Botox may benefit people with chronic migraine, a form of chronic daily headache in which people have headaches at least 15 days per month, at least eight of which are migraine. About 2 percent of adults are plagued by this crippling condition, which leaves many unable to hold down a job, do housework or have any semblance of a normal social life.

In a two-part clinical trial, nearly 1,400 people received up to five courses of Botox into specific head, neck and shoulder muscles every 12 weeks. After 24 weeks, people treated with Botox had fewer days with a migraine than those who received placebo injections. During the second phase, all participants received Botox for an additional 32 weeks. At the end of the study, nearly 70 percent of patients treated with Botox had at least half as many days with migraine. The most common side effects (neck pain and muscle weakness) were mild and short-lived, according to the study, which was published in the journal Headache in 2011—the same year Botox was approved to treat chronic migraine in the United States.

If you are a potential candidate for this therapy, be sure to find a physician with experience doing the injections. According to headache experts, doctors require extensive training to properly administer the required 31 injections in seven different locations on the head and neck.

Migraines can be debilitating and difficult to treat. But there is an unusual option: Botox.

Botox therapy is an option for people who have migraines that last four hours or more, 15 times a month. Botox is administered as an injection into the skin in different sites at the front, sides and back of the head, as well as the back of the neck. These injections paralyze and then relax the muscles at these sites, which can reduce triggers for migraine headaches.

The response usually is very good depending on the severity of the migraines themselves. Overall, people think that it decreases the intensity and duration of their migraine headaches significantly.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.