How Is Botox Used to Treat Migraine?

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Botox for migraine is a very exciting treatment that we now have available for migraine patients. In 2010, the FDA approved it for chronic migraine, which is again headache greater than 15 days a month. Prior to that time, we were injecting patients with Botox in what's called an off label fashion meaning that it was not after it yet to be approved and, we were still seeing benefits, and in 2010 I did two studies that really proved the benefit, and since that time, I've been using very frequently in my practice with excellent results.

Now in order to qualify for Botox for migraine, you have to have at least 15 headache days a month, and you have to have tried and failed two or three of the cheaper, more conventional medication, and it's not totally unreasonable that the insurance company has asked for that because often the cheaper medications do work.

But for a patient who fails two or three of these, they're typically qualified meaning that their insurance will cover the treatment. So the treatment involves 31 injections in the forehead, in the temples, the back of the head, and the neck and shoulders. 31 sounds like a lot, but the whole procedure takes 5 - 10 minutes with a very small needle.

It takes up to two weeks to see the onset of a benefit, although some patients experience benefit after a couple of days and the treatment effect is approximately three months. So the typical course is patients come in every three months for their injections. Now, part of the reason that I'm such a fan of Botox for chronic migraine, is because it's been shown to be safe and it doesn't have side effects.