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Is Botox Used To Treat Migraines

Botulinum Toxin Injectables For Migraines

Treating Chronic Headaches with BOTOX Injections

    Wrinkle-reducing treatments that use botulinum toxin injectables may also be used to treat chronic migraines. These treatments, known as neuromodulating drugs , were approved by the U.S. Food and Drug Administration in 2010 for migraine treatment.

    Plastic and reconstructive surgeon Sashank Reddy, M.D., Ph.D., explains how these drugs are a powerful treatment option for patients with chronic migraines.

    What You Need To Know

    • The injectables used to treat migraines are the same kind used by aesthetic surgeons and dermatologists to minimize facial wrinkles.
    • Licensed medical professionals treat migraines by injecting botulinum toxin into multiple areas around the head and neck.
    • The treatments are approved for select people age 18 and older who experience 15 or more migraine days per month.
    • It may take four weeks or more after treatment before you see a reduction in the frequency of your migraines, and more than one set of injections may be needed.

    How Do Botulinum Toxin Injectables Help Treat Migraines

    Researchers are eager to learn how botulinum toxin-based drugs help relieve migraine pain. Evidence suggests that the drug interrupts the pathway of pain transmission between the brain and nerves that extend from the spinal cord.

    When you have a migraine, your body releases substances called neurotransmitters and molecules that are associated with pain. Botulinum toxin interferes with the transmission of these substances, typically where the nerves and muscles meet. Researchers think that when the drug is injected into the muscles around the face, head and neck, it is taken up by the nerves and interferes with pain-associated neurotransmission.

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    Your Insurance May Or May Not Cover It

    Because it’s an FDA-approved treatment, your health insurance may cover all or most of the cost of Botox, though this depends on your specific plan. The drug manufacturer also offers a savings program that can help offset some of the expense.

    To get approval, your insurance company may want to see that you’ve “failed” on two or three oral preventatives first. You may also need to keep a headache diary that shows you’re having 15 or more headache days per month.

    Once you’ve started the shots, your insurance will probably require documentation of improvement to continue paying for the treatment. Depending on your plan, you may also need to come for a follow-up visit between shots.

    Note, however, that if Botox is used as an off-label treatment , insurance companies may not cover it, per the AMF.

    What Type Of Headache Responds Best To Botox

    Botox and Migraines: Your Questions Answered

    Botox is only FDA-approved for chronic migraines, which means headache on 15 or more days a month. The more frequent the headaches, the better the patient does with Botox, says Dr. Andrew Blumenfeld, Director, The Headache Center of Southern California. Botox is not recommended for patients who experience fewer than 15 headache days a month.

    Read Also: Natural Remedies For Vestibular Migraines

    What To Expect During Botox Treatment

    Before your first Botox treatment your neurologist should discuss the side effects and risks. This is a good time to ask questions and check if they follow the established Botox protocol for chronic migraine.

    Your neurologist uses a small needle to inject 0.1ml or 5 units of Botox at each site just under your skin. You may feel a slight sting with each injection. Because Botox comes in 100 unit vials some neurologists may do a few more injections around areas where you experience your migraine pain.

    The treatment takes about 1520 minutes and there arent any restrictions on driving or other daily activities after treatment.

    Its important to remember Botox isnt a quick fix for migraine. It often takes 2 or 3 treatments to notice if its effective in reducing the frequency or intensity of your migraine pain. Botox treatment is repeated every 12 weeks, which means it may take 69 months to notice any difference. Some people have reported improvements after their first treatment, so like many migraine treatments results are very individualised.

    Many people report the benefits of Botox start to wear off after about 10 weeks, and the intensity and frequency of their migraine attacks increase close to their next treatment date.

    You dont need to stop taking other preventative medications with Botox treatments and you can continue to use abortive medications if you need them.

    Management And Pharmacologic Treatment

    Diagnosis of CM is based on the patients history and neurological examination. In some patients, cerebral magnetic resonance imaging and lumbar puncture might be necessary in order to rule out secondary causes for headaches .

    The main goal in the treatment of CM is to reduce the impact of migraine on patients lives. Therefore, it is necessary to keep migraine attacks as rare, short and as less-impairing as possible. Various nonpharmacological measures are useful to prevent migraine attacks: trigger avoidance , dealing with risk factors .

    Pharmacological treatment of CM is based on two pillars: abortive treatment of acute migraine attacks and prophylactic treatment. The substances most commonly used for the abortion of migraine attacks are nonsteroidal anti-inflammatory drugs and triptanes. There is good clinical evidence, that both substance groups are effective in the abortive treatment of acute migraine attacks. On the other hand, it has been shown, that both NSAIDs and triptanes may lead to medication overuse headaches. Therefore, the challenge is to restrict migraine-abortive substances to the least amount necessary. This observation highlights the special importance of prophylactic treatment in patients with CM. Generally, prophylactic medication can be given as soon as the diagnosis of CM is established. The choice of which substance is applied should be made with regard to the patients comorbidities .

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    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.

    How Effective Is It

    Botox For Migraines

    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.

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    How Does Botox Work

    Botox is injected around pain fibers that are involved in headaches. Botox enters the nerve endings around where it is injected and blocks the release of chemicals involved in pain transmission. This prevents activation of pain networks in the brain.

    Botox prevents migraine headaches before they start, but takes time to work. I look to the second and third treatments to maximize effects, says Dr. Andrew Blumenfeld. Patients see in

    creasing benefit with an increase in the number of treatment cycles. One treatment lasts for 10-12 weeks, and patients reported that two Botox treatments reduced the number of headache days by approximately 50%.

    Let Us Help You Find Real Pain Relief

    As we mentioned earlier, we truly sympathize with those who have to deal with the pain caused by chronic headaches and migraines.

    Weve seen how debilitating such pain can be to our South Shore area patients in Hingham, Hanover, and Weymouth. We have helped them to find real relief from their pain, and we are confident that we can help you!

    Therapeutic Botox for migraines has little to no side effects, and its fast and effective.

    Just fill out the consultation request form, and well do the rest.

    Or, if you would like to talk with us directly about Botox for migraines you can:

    • and chat with us

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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.

    Should Botox Be Used For Any Person With Migraine

    Pin by Val Sto Rie on yep

    No. Botox is approved only for Chronic Migraine. Chronic migraine is the most severe form of migraine. 1 to 2% of the population suffers from chronic migraine. These people have more than 15 days of headaches a month for at least three months, 8 or more of which are migraines. The other days can be «tension type», as the severity of headache varies in Chronic Migraine .

    Unfortunately, Botox does not work for people who have a less severe form of migraine called episodic migraine. Studies on people with episodic migraine were negative. You may want to see a headache specialist to discuss if Botox would be right for you.

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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.

    What Can I Expect When I Receive Botox Injections For Migraine

    Botox injections to prevent headaches in adults with chronic migraine are generally safe, but they may cause some mild side effects. To learn more, see the Botox side effects section above. You can also refer to the Receiving Botox injections section above and talk with your doctor.

    Botox is approved by the Food and Drug Administration to prevent headaches in adults with chronic migraine.

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    Will It Work For Me

    Botox aims to reduce how often you have migraine attacks and how severe they are.

    Most people have at least two treatment cycles before deciding if Botox is effective. A good response to Botoxis usually a 30-50% reduction in how many headaches you have. Doctors will also consider any improvements in your quality of life. Some people notice an improvement in their quality of life with Botox even if they dont have a big reduction in headache days.

    Onabotulinumtoxina And The Cgrp Antagonists

    Treating Migraines with Botox

    With the advent of monoclonal antibodies directed against CGRP or its receptor , the landscape in chronic migraine prophylaxis has shifted. In many jurisdictions, the use of these newer therapies will also be limited by cost.

    There have been no head-to-head trials between OBTA and the CGRP-As. The placebo controlled trials are not directly comparable, but in the pooled PREEMPT trial data, OBTA reduced headache hours per month by 39 h more than placebo at six months , compared, for example, to a reduction of 19 h per month more than placebo by erenumab at 3 months . OBTA was also being compared to a much larger placebo response. In the PREEMPT trials, the reduction in headache hours per month from baseline by placebo was 80, versus 55 in the erenumab study. Galcanezumab reduced headache hours per month by 23 and 18 hours more than placebo during the first three months of therapy in a chronic migraine study

    Although follow up for several years of patients enrolled in an erenumab clinical trial has revealed no safety concerns , long-term safety remains an issue with the CGRP-As, as CRGP, which has many functions throughout the body, is blocked on a systemic level. In contrast, in the doses used in chronic migraine, OBTA has primarily local effects without concerns about systemic side effects.

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    What To Expect At The Clinic

    You should bring along your headache diary to the clinic appointment. You should record how many days you have migraine and headache, as well as the number of days you use a pain relief treatment.

    Many people are understandably anxious about having the 31 injections on their head, neck and shoulders. However, most are surprised at how well they tolerate these very small, superficial injections. The injections are placed with a very fine needle in the forehead, temple area, back of the head, upper neck and shoulders.

    The actual injections can be done in 10-15 minutes. However, before the procedure is done, your nurse or doctor will take some time to look at your headache diary, discuss your headache pattern, explain the procedure and allow you time to ask questions.

    For most people the injections are done while you are sitting . The injections might be uncomfortable and sting for a few seconds, but this settles quickly.

    It is best to come without make-up but the skin will be cleaned prior to the injections, to reduce the chances of infection.

    Benefits Of Botox Treatment

    Apart from the obvious benefits of reduced migraine frequency and severity, BOTOX® offers a number of other advantages for patients, including:

    • The injection process is quick, simple and relatively painless.
    • Patients dont need to be sedated in any way and can drive themselves home afterward.
    • Results can begin within 72 hours after injection, although this typically only happens after the second treatment.
    • Side effects are minimal compared with many other migraine medications.

    BOTOX® can help chronic migraine sufferers tremendously by reducing the number of attacks they experience, but it is still considered a preventive treatment rather than a cure.

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    Botox Injections For Sialorrhea

    Sialorrhea is a neurological condition that results in excess saliva and subsequent drooling.

    Sialorrhea, or excessive drooling, is a major issue for children with cerebral palsy and adults with neurological disorders like amyotrophic lateral sclerosis or Parkinsons disease.

    Botox injections for sialorrhea involves administering Botox in the salivary glands using ultrasound to guide the needle.

    Botox effectively blocks the function of the salivary glands, which decreases the amount of saliva produced. Botox injections for sialorrhea is an ongoing treatment typically repeated every three to four months.

    Botox used to treat excessive drooling is covered by most medical insurance providers including Medicare and Medicaid.

    Does Botox Work For Migraine Headaches

    Can Botox Prevent Chronic Migraines?

    In a study of adults who get chronic migraine headaches, shots of Botox cut down the total number of days they had them or even other types of headaches. They also had more “crystal-clear” — pain-free — days each month, and they reported fewer days off work.

    In another study, nearly half the people who took two rounds of Botox shots reported that the number of days they had a headache each month was cut in half. After five rounds of treatment, that increased to about 70% of the people.

    Doctors think Botox works for migraine headaches because it blocks chemicals called neurotransmitters that carry pain signals from your brain. Botox is like a roadblock in that pathway. It stops the chemicals before they get to the nerve endings around your head and neck.

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    Botox Injections For Dystonia

    Dystonia is a movement disorder characterized by involuntary muscle contractions, affecting one or more parts of the body. Dystonia can be treated with Botox injections in a localized manner .

    Botox injections for dystonia involves blocking the neurotransmitter chemicals that signal the muscles to contract and spasm. Botox used at cosmetic surgery facilities is the same Botox used to treat dystonia however, the injection location and dosage is different, depending on the patient.

    Botox injections for Dystonia is an ongoing treatment plan typically repeated every three to four months, which gives your provider the incredible benefit of adjusting injection sites to optimize efficacy.

    Botox used to treat dystonia is covered by most medical insurance providers including Medicare and Medicaid.


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