How Does Botox Treat Migraines
Migraines, for those who are unfortunate enough to have them, can leave you drained. Not only are they painful, but the sensitivity to light and sound can leave you immobile for hours. The throbbing and pulsing pain is rarely helped by conventional medications and time usually does the trick to help it go away. Over the counter pain medication may be effective to some extent, but that does not stop the migraines from coming back. Chronic migraines are classified as occurring 15 days a month imagine having to suffer through that! This is where Botox treatment comes in.
Botox is derived from clostridium botulinum, which is a bacterium that causes paralysis. Having been commonly used to remove wrinkles and make you look younger, Botox benefits extend further than just cosmetics! For those suffering with hyperhidrosis , Botox can help treat it.
As for pain management and migraines, Botox injections can prevent chronic migraines for up to three to twelve months! Thats a long time. The FDA approved this treatment on October 15, 2010 and it has been very effective! The way this works is that the Botox is injected into seven areas of the head and neck, for a total of 31 injections. Neurologists inject Botox in the front and back of the head and neck in a symmetrical pattern. These injections are repeated over aninterval of twelve weeks to a year. However, this treatment is effective for chronic migraines if you have migraines that arent as frequent, this wont help very much.
Botox For Chronic Migraine
Large clinical trials were done to study whether Botox prevented migraine. The results showed that Botox reduced headache and migraine days.5,6 Based on these results, the FDA approved Botox for chronic migraine prevention in 2010.2 Botox does not work for people with episodic migraine.
Botox works by binding to certain areas, known as receptors, on nerves and muscle fibers. This blocks the release of specific brain chemicals, including acetylcholine. This, in turn, blocks muscle activity.2 It is not completely known how Botox reduces headache pain and stiffness. A potential reason might be that Botox blocks nerves that send pain messages to the brain and relaxes muscles so they are less sensitive to pain.
Botox is injected into the muscles of the neck and face by a doctor. There are 31 injection sites. It is given every 12 weeks. Some patients see results at week 4. It may take up to two treatment cycles to achieve maximum benefit.7
Many insurance companies require that people with chronic migraine try other preventive medications first before they will cover Botox for migraine prevention.8
What Is Botox For Migraines
Botox is a neurotoxin derived from Clostridium botulinum bacteria. Small amounts of Botox can be injected into the skin and temporarily prevent nerve cell signals from reaching the muscles. When this happens, Botox paralyzes the muscles and reduces abnormal muscle contraction.
Although Botox injections are commonly associated with non-invasive facial rejuvenation procedures, Botox has been used in other medical applications, including migraine treatments. The Migraine Institute offers Botox injections to individuals who have received a chronic migraine diagnosis from a neurologist and find that migraine medications cause intolerable side effects or fail to alleviate migraine pain.
Dr. Jonathan Cabin of The Migraine Institute is a board-certified head and neck surgeon with dual-subspecialty training in facial plastic and reconstructive surgery. This unique expertise enables Dr. Cabin to determine if Botox injections can help chronic migraine patients address their migraine symptoms.
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Does Insurance Cover Botox For Migraines
Its important to keep in mind that insurance companies will only cover Botox treatments if you have tried and failed two other treatment options for your migraines. To verify this, they may ask that a prior authorization form be submitted with the healthcare provider who prescribed it or from where these drugs came through their migraine program at no cost as an incentive before considering coverage on anything else aside from medication costs like lost wages during downtime due illness. The bottom line here? Make sure there is nothing but success ahead by ensuring all possible courses of action have been exhausted first!
What To Expect When Using Botox For Migraines
If you choose to use Botox for migraines, a board-certified physician for Botox usually a neurologist can administer the treatment. They will inject it in the forehead, above and between the eyebrows, the base of the skull, and the neck, says Green. These spots are points of discomfort for migraines.
Botox injections only take a few minutes and should not cause much pain. After receiving treatment, keep your head upright for a minimum of four hours and avoid massaging the injected areas for three days.
“Rubbing the area of treatment can result in moving Botox to unwanted areas. Botox is superficially injected, therefore, it needs an adequate amount of time without movement for it to dissipate fittingly,” says Green. Refrain from exercise the day of treatment as it can increase your blood pressure, potentially causing bruising and swelling.
Patients can begin to feel migraine relief within seven to ten days following treatment, says Shah. However, Danan adds that some people may require multiple sessions to feel results.
“After the injection, we typically see the most efficacy at the six-week post-injection mark, and then relief until the toxin disassociates from the receptor at 12 weeks,” says Shah.
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It Can Take Several Months To See Results
If you don’t experience relief from migraine right away, don’t swear off the treatment immediately. Dr. Najib recommends trying two rounds of Botox before making a decision about whether it’s working for you. Even if the treatment ends up helping after the first round, he says results typically take two to four weeks to kick in. There’s no taper required to discontinue the treatment.
Onabotulinumtoxina Inhibits Ion Channel Insertion Into Synaptic Membranes
Migraine headache is commonly associated with throbbing and increased headache intensity caused by mild elevation in intracranial pressure due to coughing, sneezing, or bending over.- These symptoms are believed to result from sensitization of nerve endings of first-order sensory neurons â a functional switch involving upregulation of pain-related ion channels on nociceptive nerve terminals and cell bodies, including TRPA1, TRPV1, and sodium channels. Repeated stimulation of trigeminal nerve endings and their eventual sensitization can lead to the development of central sensitization, ongoing pain, allodynia , and hyperalgesia .,
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Mayo Clinic Q And A: Botox A Treatment For Chronic Migraines But Not A Cure
DEAR MAYO CLINIC: Is it safe to use Botox injections to treat chronic headache? How does it work, and would I need to have regular treatments? Do patients who use Botox as treatment need to be on other headache medication, too?
ANSWER: Onabotulinum toxin A, or Botox, is approved by the U.S. Food and Drug Administration as a treatment for chronic migraine headaches. It is not a cure. People who receive Botox for headaches usually get the treatment about every three months. For some, that is all they need to keep their headaches under control. For others, additional medication or other headache treatment is necessary.
Botox is a medication that uses a form of botulinum toxin to paralyze muscle activity temporarily. Best known for its ability to reduce the appearance of facial wrinkles, Botox also has been shown to help prevent chronic migraine headaches in some people. Its used mainly for those who have headaches more than 15 days a month.
Since 2002, doctors at Mayo Clinic have treated thousands of patients with chronic migraine effectively and safely using Botox. The medication typically is injected into muscles of the forehead, scalp, neck and shoulders.
The specific details of how Botox works to prevent headaches are not known. But, its likely that the injected Botox is taken up by pain receptors in the muscles nerves. The medication then deactivates those pain receptors and blocks pain signals that the nerves send to the brain.
How Does The Procedure Work
Wondering what you can expect if you opt for BotoxÂ® treatment? Your first appointment will only take about 20 minutes. Using a very small needle, your doctor will inject BotoxÂ® into the muscles on your head and neck. The injection sites will differ depending on where you feel pain during a migraine, but you can expect to get anywhere from 20 to 40 shots in one session. As scary as that might sound, you can go home right after the procedure and go on with your life, no bed rest required.
And if youâre hoping to get a little boost to your skinâs appearance while youâre at it, just ask your doctor to keep the injections symmetrical and aligned with the wrinkles youâre trying to smooth. Because why not kill two birds with one stone when itâs this easy?
After your first treatment, you may need to wait 12 weeks and then do another round before you can figure out if itâs effective for you. Some sufferers donât see results until their third treatment, which means you may end up waiting a full six months just to find out BotoxÂ® doesnât work for you. If it does work, all you need to do is keep getting the injections every 12 weeks, which only adds up to four times a year.
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How Effective Is It
The goal is not to become completely free of headache or migraine but to improve quality of life, and to convert migraine from chronic to episodic.
About one in four patients do not respond one in four respond well to the first or second set of injections, and half need more than two sets of injections to get a good response. Studies show that 47% of patients had a 50% or greater reduction in the number of days with headache.
The biological effect of botulinum toxin on nerves takes several days or a few weeks to work. You should not expect chronic migraine to improve properly in less than 4 weeks. Some patients do not start to improve until after their second set of injections which is given 12 weeks after the first set of injections.
How Can I Find A Competent Injector
Go to: mychronicmigraine.ca website.
This website provides a list of injectors that you can search by city or postal code.
Note that BOTOX® injectors may include neurologists, pain specialists, headache specialists, anesthesiologists, family physicians, physiatrists and other medical professionals experienced in treating migraine. Some injectors might provide injections but not a global management of migraine.
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You Can Technically Get Botox For Migraine And For Cosmetic Reasons At The Same Time
This is where it gets a little murky, and opinions vary depending on who you ask. The manufacturer of Botox recommends not exceeding 400 units in a three-month span. Since your neurologist will administer 155 units, technically you have wiggle room if you want to visit an esthetician for Botox, too. However, this can be problematic.
“There is a theoretical risk of developing antibodies to Botox if it’s given more frequently,” explains Dr. Donnelly. If you’d like to do both, it’s best to check with your provider before booking an appointment with your esthetician.
Overall, if you’re finding yourself planning your life around your migraines, you may want to make it a point to chat with your doctor about using this multitasking drug to reduce the frequency of the attacks. I know doing so has drastically changed my life-and it might help you, too.
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Understanding The Basics About Botox
Botox is a medical product thats used for a variety of both cosmetic and pharmaceutical purposes. Its derived from botulinum toxin, which is a toxic substance produced by a bacterium called clostridium botulinum.
Though botulinum toxin is extremely toxic, it can be safely used in very small amounts in Botox. When injected into the face or another area of the body, the toxin in Botox blocks the nerve signals that cause your muscles to move.
For cosmetic purposes, this helps smooth out wrinkles and laugh lines, and provides you with a smoother, more youthful face. But the same method of selective muscle paralyzation can also be used to treat a variety of medical issues, including migraines.
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Botulinum Toxin Side Effects
The most common adverse reactions reported by patients being treated for chronic migraine have been neck pain and headache, the FDA says.
The FDA also has placed a boxed warning on the anti-migraine drug, onabotulinumtoxinA, marketed as botulinum toxin . The warning says the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism.
These symptoms can include swallowing and breathing problems. The FDA says it knows of no confirmed cases of the spread of the toxin effect when botulinum toxin has been used at the recommended dose to treat chronic migraines, severe underarm sweating, or conditions such as blepharospasm, an involuntary muscle spasm in the muscles surrounding the eyes.
The drug also can cause muscle weakness, double vision, blurred vision, drooping eyelids, loss of bladder control, and hoarseness, Allergans statement says.
The same formulation of botulinum toxin was approved by the FDA in 2002 for the treatment of facial frown lines.
The FDA says botulinum toxin does not appear to be useful in treating or preventing less frequent migraines that occur 14 days or less per month or other forms of headache.
Botox For Migraine Injection Sites
Botox is an amazing medication that can prevent migraine headaches or attacks before they start! Its injected into 7 specific muscle areas around your head and neck, including the forehead beside each temple near where it meets behind-the eye on either side of our nose bridge called crows feet also known as bug Tea pot syndrome) at back edge close up towards shag area above shoulder blades .
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How Else Can I Prevent Migraine Attacks
If all this has you thinking that maybe BotoxÂ® isnât the best option for you right now, weâve got you covered. In addition to the medications we just mentioned, you could also consider anti-CGRPs, supplements, or lifestyle changes like getting more exercise or improving your stress management. You can find details on the pros and cons of each of these in our guide to BotoxÂ® alternatives.
Letâs recap. BotoxÂ® is an effective preventive treatment for chronic migraine that comes with minimal risk of serious side effects. But itâs expensive, inconvenient, and by no means guaranteed to work for you.
If your attacks are taking over your life, a Cove doctor can recommend the right preventive treatment for your needs. Plus, weâll deliver it directly to your doorâno office visits required. Get started today with an online consultation.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Should I Pay Injection Fees To The Physician Or The Clinic Where I Receive The Injections
This is very variable. Access to care in Canada is supposed to equitable between provinces but it is not the case for migraine care and this is one example.
Alberta and Quebec have fee codes but other provinces dont. Physicians then have to charge fees directly to patients . Fees may vary between $100 and $200. If you receive your injections from a cosmetic physician, fees might be higher.
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What Is The Process For Using Botox To Treat Migraines
The process for using Botox for migraines can vary according to your treatment plan and in consultation with your physician. A general course of action includes four treatments per year, with each injection taking about 15 minutes. Injections are performed with a tiny needle and you may feel pinches.
In each procedure, Botox is injected into seven specific muscles around the head and neck, including the forehead, bridge of the nose, temples, neck, back of the head, and just above the shoulder blades.
What Is The Likelihood That Botox Will End My Migraines
Studies have shown that long-term treatment using Botox is effective, safe, and well-tolerated among patients.Success rates of 65% after three treatments roughly 6 months from the first injection have been reported.Botox rarely completely eliminates migraines. Instead, it reduces the number of days per month they occur on. In two recent studies, those who received Botox experienced 9 fewer headache days per month.
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Rationale For Onabotulinumtoxina For Chronic Migraine Treatment
Sensory effects of onabotulinumtoxinA in migraine are supported by findings from preclinical studies, which established that BoNTA inhibits the release of neuropeptides such as substance P, and CGRP from primary sensory neurons. Sensory effects of onabotulinumtoxinA are also demonstrated in the formalin pain model, in which subcutaneous injection of onabotulinumtoxinA dose dependently inhibits the delayed pain response to formalin without affecting the acute pain response and without inducing muscle weakness. In clinical studies, there were early suggestions of a dissociation between pain and muscle relaxation in cervical dystonia, with some studies reporting more prevalent improvements in pain than muscle contractions., Additionally, a spasticity study that specifically examined the relationship between pain and muscle tone found only a weak correlation between them, consistent with the notion that onabotulinumtoxinA-associated improvements in muscle tone and pain are separate dimensions. OnabotulinumtoxinA has also shown benefits in the treatment of other pain disorders, including painful diabetic neuropathy, a primary sensory disorder. The combination of these findings provides a clinical basis for understanding the sensory effects of onabotulinumtoxinA in chronic migraine and are further confirmed in the laboratory studies described in the subsequent section.