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Where Do You Inject Botox For Migraines

Are The Injections Painful

The needles used for Botox injections are very small and a skilled injector will do them fast enough, but needling is never agreeable. 

If you have allodynia related to your chronic migraine, or if you are in the midst of an attack, injections can be more painful. Controlling your breathing is a good way to decrease the pain , especially if you are very nervous. If Botox is effective for you, the likely scenario is that the injections will be easier to tolerate over time. 

When Should I Feel The Results

The effect of Botox is not felt immediately after the injections. It takes 7 to 10 days on average. The protein takes time to be transported to the zone where it becomes active. An increase in headaches and neck pain is sometimes seen during the first week after the injections. The effect from the previous treatment has worn off and the new treatment did not kick yet. Discuss this with your physicians to find solutions.

Botulinum Toxin Injections For Preventing Migraine In Adults

Bottom line

People with chronic migraine treated with botulinum toxin injections had two fewer migraine days per month than people treated with placebo . It is unclear if this improvement was large enough to make a meaningful difference to their lives. More work is needed to show whether botulinum toxin is better than oral treatments , that prevent migraine. The evidence for botulinum toxin for people with episodic migraine was uncertain. Treatment with botulinum toxin did not cause many side effects.


Migraine occurs in three in 20 adults and three in every four sufferers are female. People who have 15 or more days of headache in a month, with eight or more of those days being migraine, have chronic migraine. People with fewer than 15 days of headache in a month have episodic migraine. We included trials that compared botulinum toxin treatment with placebo injections of salt water, different doses of botulinum toxin, or other oral treatments to prevent migraine. We collected information for the following outcomes: number of migraine days in a month ; migraine severity; use of medications for migraine symptoms; disease-rating scales; quality-of-life scales; side effects; and cost effectiveness of treatment.

Trial characteristics

Key results

Disappointingly, there was not enough detail in the trial reports about many important measures of disease for us to study them.

Quality of the evidence

Description of trials

Botulinum toxin versus placebo

Dosing trials

Are Botox Injections Covered By Insurance

If youve been diagnosed with chronic migraines and failed to respond to other treatments, Botox may be covered by your insurance provider. Depending on your insurance, you may have to pay for a portion of the procedure or meet a simple co-pay.

Check with your insurance provider to confirm your actual out-of-pocket costs.

Who Can Take Botox

Botox for Migraines: How the Injectable Stops Severe Headaches

Patients suffering from a chronic migraine, in which a headache is known to occur for 15 or more days of a month out of which 8 days are with a migraine, can take Botox.

This is not the only way of treating migraine. One needs to consult with the doctor to know about other methods as well and then choose the one that best suits them. A visit to the migraine clinic would let the patient show all his medical history, according to which the treatment can be carried out.

Botox should be taken only from a trained injector who has received proper training regarding its diagnosis as well as treatment.

Botox is known to contraindicate in the following situations:

  • When there is an injection in the site at which the injection is applied.
  • Patients who are hypersensitive to botulinum toxin type A or to any constituents used for the formation of Botox.
  • It might affect negatively during pregnancy, so must not be taken without doctors advice.Similarly, lactating mothers should avoid taking this as it can affect the newborn by passing through the milk.
  • Patients having neurological problems such as difficulty in swallowing are at greater risk of having side effects from Botox. Persons with peripheral motor neuropathic diseases also require extra caution while being administered with the doses.
  • Patients having neuromuscular disorders might face severe side-effects such as acute dysphagia and respiratory compromise on the application of typical doses of BOTOX.
  • How Often Do I Get Botox Injections For Migraine

    In general, most people start with 2 treatments, 12 weeks apart, and then treatment is continued every 12 weeks. You will receive injections 4 times per year or as directed by your healthcare provider.

    Some patients may feel headache results as soon as 4 weeks. Follow your doctors instructions exactly.

    Patients Have Reported Neck Pain And/or Weakness With Botox Injections What Tips Do You Have To Avoid/minimize This

    The patients neck stability, posture, torsion, and symmetry should be assessed to determine whether he or she may be at increased risk for adverse events prior to the first injection cycle. A patient with preexisting neck pain and/or weakness may be at higher risk for exacerbation of the condition upon injection of the occipitalis, cervical paraspinal, or trapezius muscle groups. Patients with smaller frames may be at higher risk for neck weakness. Indicated injection sites can still be injected with minimal side effects and unwanted outcomes as long as correct injection sites are targeted and treatments are administered using a superficial approach with avoidance of the mid and lower cervical regions. The cervical paraspinal muscle group is made up of multiple muscles including the trapezius, splenius capitis and cervicis, and semispinalis capitus. This group of muscles helps support the neck, including extension of the head.

    Does Botox Work For Migraine Headaches

    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” — -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 . Botox is like a roadblock in that pathway. It stops the chemicals before they get to the nerve endings around your head and neck.

    How Soon Do Migraines Improve After Botox

    You should experience some improvement in your migraines within the first two weeks after your first botox treatment. If you dont feel a reduction after one treatment, it is very likely you will respond well to your second treatment.

    With continued treatment, you should notice a reduction in migraine pain and frequency that lasts for several weeks. The longer you continue with treatment, the better your results will be.

    Why Theres More To It: Migraines And Temporomandibular Joint Disorder

    As you can probably tell by this point, the theme with migraine research is that we need to know more than we currently do. I find that people who suffer from migraines suffer for a long time. Even with medication, some still hurt. Something doesnt add up in those circumstances. People shouldnt be suffering when they are taking numerous medications for migraines.

    My advice to you is dont lose faith and keep searching for a better solution. Maybe its botox for migraines, and maybe its not for your particular case. The point is there will be a treatment that works best for you. Dont lose hope in researching possible solutions.

    In my practice, we treat patients with severe TMJ disorder, some of the most severe in the country to be exact. Do you know what they also usually have when I first meet them? Migraines and headaches. Thats not a coincidence.

    Heres the reason why: The muscles of the jaw and TMJ are connected to the head. If the patient has strain from their jaw, from their neck, or from their posture theres a good chance theyll will be susceptible to headaches.

    The point is if you have been trying a particular treatment for migraines and its not working, talk with your doctor to test another option. Have your jaw evaluated as a possible source. Review your posture throughout the day. Explore if botox can treat the muscles. And have your neck and spine checked to see if there is an orthopedic or neurologic component.

    How Is It Given

    BOTOX ® is given as a series of 31 to 39 tiny injections under the skin or into the muscles in and around the head of the forehead, above the ears, and into the neck and shoulders. The injections are repeated every 12 weeks until the patient no longer has chronic migraine, or until it is clear that treatment is not working.  Normally a response is seen after the first or second set of injections; only about one in ten people respond to a third set of injections if the first two sets fail.

    Should I Be Worried About The Side Effects Of Botox

    The thought of injecting a toxin into your bodyespecially your headmight seem kind of scary. Rest assured, however, that when a qualified doctor administers the correct dose, the risks are low and the side effects are generally mild.

    A small number of patients report neck pain, injection site pain, headaches, droopy eyelids, or muscular weakness. These side effects typically dont last for very long, and, in many cases, are much more tolerable than the symptoms associated with chronic migraines.

    Isnt It A Treatment For Wrinkles

    Five Questions with Dr. Miller About Botox for Migraines ...

    Botulinum toxin gets into nerve endings and stops the nerve being able to respond normally to an electrical nerve impulse. Whatever that nerve normally does, stops working. So when facial expression muscles are injected, facial wrinkles are reduced. It was noticed by chance many years ago that people having cosmetic botulinum toxin had fewer headaches. Recently this was proven to work for chronic migraine; it is also used to treat other illnesses including hemifacial spasm, dystonia, cerebral palsy, and stroke.

    Does Insurance Cover Botox For Migraine

    If you are wondering how much Botox for migraine cost, it is expensive. However, most insurance companies in the United States approve some part of the treatment. To qualify for Botox for migraine you need the following:

    • You must have a chronic migraine diagnosis, meaning you must have 15 or more headache days a month.
    • Most insurance companies require that patients fail to respond to or experience side effects to at least 2 or 3 other preventive medications.

    Allergan offers a Botox Savings Program which could help you with out-of-pocket costs not covered by insurance.

    Can Any Physician Inject Botox For Migraine

    Injecting Botox for is not a difficult procedure, but it has to be done by a health care provider with proper training and experience, according to a specific protocol called PREEMPT. When you choose an injector, make sure that the proper protocol is followed, and adapted to your needs. You may use the website where you will find a research locator for trained injectors.

    Candidates For Botox Injections For Migraines

    BOTOX injections have received United States Food and Drug Administration approval for treating migraines in adults at least 18 years old who have been diagnosed with chronic migraines. In clinical studies, BOTOX injections were shown to be a safe and effective treatment for those who have 15 or more days of headaches each month, and whose headaches last for at least 4 hours. BOTOX treatment reduced the number of days that study participants experienced headaches by as many as 9 days a month . Migraines that do develop are often less severe than those experienced prior to BOTOX treatment.

    BOTOX injections may be a successful treatment for chronic migraine sufferers whose headaches have not responded well to, or who have experienced rebound headaches from, other migraine medications. Studies have not yet confirmed whether BOTOX Cosmetic is an effective form of treatment for episodic migraines, which occur 14 or fewer days per month.

    The Risk Of Side Effects Is Low

    “Botox injections can occasionally trigger a headache, muscle weakness and neck pain, but this is rare,”Kerry Knievel, DO, director of the Jan & Tom Lewis Migraine Treatment Program at Barrow Neurological Institute in Phoenix, Arizona, tells Health. “Eyelid and eyebrow asymmetry and droop can happen, but to prevent this we recommend that patients refrain from rubbing their foreheads or wearing a hat for 24 hours after their injections to prevent the Botox from spreading from the area we intend for it to be.”

    In fact, Botox’s limited side effects are part of its appeal. “It’s not addicting. You don’t have to take a pill every day. It doesn’t work for everyone, but it does work for a significant amount of people. That’s why Botox is amazing,” says Dr. Bashir.

    How Do I Access Botox

    Botox is only available on the NHS for people with chronic migraine who have tried at least three other preventive treatments. It is currently only available via a specialist such as a headache specialist or consultant neurologist.

    If you think you are eligible for Botox and would like to considered for treatment you can ask for a referral to a specialist. The specialist will assess your history and symptoms to make sure Botox is an appropriate treatment option for you. You should be asked to keep a headache diary to monitor the effectiveness of the treatment.

    If Botox doesnt work for you or stops working your specialist will discuss other treatment options with you.

    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.

    Can I Get Botox And Botox Cosmetic At The Same Time

    Yes, you can receive Botox and Botox Cosmetic for different uses at the same time as long as the total dose received of onabotulinumtoxinA does not exceed 400 Units administered in a 3 month period for adults.

    The dilution and the resulting units per 0.1 mL are different between Botox and Botox Cosmetic. Health care providers should see the specific instructions for reconstitution and administration of each product.

    Warnings: Botox and Botox Cosmetic may cause serious side effects that can happen hours, days, or weeks after an injection and can be life threatening. These include:

    • Problems breathing or swallowing
    • Spread of toxin effects

    According to the manufacturer, there has NOT been a confirmed serious case of spread of toxin effect away from the injection site when Botox has been used at the recommended dose to treat chronic migraine or when Botox Cosmetic has been used at the recommended dose to treat approved wrinkle areas.

    Why Might I Need Botulinum Toxin Injections For Migraine Treatment

    Botox For Migraine Procedure

    Botulinum toxin treatments have been proved effective in clinical trials, and are one way to treat chronic migraines. Other medications, and lifestyle changes, might be recommended. If your doctor determines that you have chronic migraines, you might be a candidate for this treatment.

    Sashank Reddy says, Botulinum toxin injectables are part of a comprehensive suite of options that neurologists and headache specialists have for treatment of chronic migraines. While no single option is best for all cases, an approach that includes several different treatments can often reduce headache frequency and severity.

    Will Botox Work To Treat My Migraines

    Individual results may vary, so theres no way to know for sure. But theres strong reason to believe that it might.

    Multiple studies have shown that treating chronic migraines with Botox means fewer headache days each month when compared with placebo. It may take 10 to 14 days for the result of the Botox to start to take effect.

    Some people dont respond to this type of treatment for migraine, and it typically takes two treatment cycles to figure out if youre one of them.

    Is There A Needle Size And Saline Dilution That You Find Most Useful

    The ideal needle to use is a 30G or 31G, half-inch needle. Longer needles are problematic as they encourage deeper injections, which can increase the risk of muscle weakness, and most of the side effects such as neck pain stem from muscle weakness. Perseverative-free normal saline is the only diluent that should be used. There is a case study of a patient who died when onabotulinumtoxinA was mixed with a local anesthetic agent. The pivotal trial established an effective dose using 2 mL/100 units of onabotulinumtoxinA. A fact that is often overlooked is that the mean dose in the trial was 165 units. The patients all received 155 units with a fixed dose, fixed-site injection protocol, and an option of an additional 40 units to follow the pain. This resulted in a mean dose of 165 units, which is the standard that should be used to achieve the efficacy results reviewed above.

    Botox For Chronic Migraine

    BOTOX® prevents headaches and migraines before they even start

    BOTOX® prevents, on average, 8 to 9 headache days and migraine/probable migraine days a month

    For adults with Chronic Migraine, 15 or more headache days a month, each lasting 4 or more hours. BOTOX® is not approved for fewer than 14 headache days a month.

    about 10 minutes of treatment

    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.

    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.

    Our Free Guide Gives You 5 Tools For Every Day Migraine Prevention

    Holly Hazen is the creator of Migraine Savvy. Her guidance is guaranteed to give you more confidence in your ability to prepare for that next attack and recover faster. Learning resilience and coping skills now will pay off forever!

    If you like this article, please share it on your favorite social channels…

    References for botox injection for migraine:1. Botulinum Toxin Treatment Overview. Available at:   Accessed May 22, 2017.2. Emergency Medicine Understanding Migraine: Strategies for Prevention. Available at: Accessed June 6, 2011.3. The U.S. Food and Drug Administration Botox Medication Guide. Available at: Accessed on  May 22, 2017.4. Dr. Karl Ng MBBS FRCP FRACP CCT Clinical Neurophysiology Director of Neurophysiology at Royal North Shore Hospital and Consultant Neurologist and licensed botulinum toxin administrator at Sydney North Specialist Center. Discussions dated February 15, 2012 – Updated May 19, 2017.

    Important Safety Information Contraindications

    BOTOX® is contraindicated in the presence of infection at the proposed injection site and in patients who are hypersensitive to any botulinum toxin product or to any of the components in the formulation.

    BOTOX® is contraindicated for intradetrusor injection in patients with a urinary tract infection, or in patients with urinary retention, or post-void residual urine volume > 200 mL who are not routinely performing clean intermittent self-catheterization .

    When Is Botox Used

    Botox For Migraine

    Botox is approved for use on the NHS for the treatment of chronic migraine in adults. Chronic migraine is defined as having at least 15 headache days a month, with at least eight of those featuring migraine symptoms.

    It is not an effective treatment for other types of headache including episodic migraine , tension-type headache and cluster headache.

    Botulinum toxin is used to treat other conditions such as hemifacial spasm, cervical dystonia, cerebral palsy, bladder pain, lower back pain, neuropathic pain and stroke.

    In England and Wales, the National Institute of Health and Care Excellence recommends the use of Botox for people with chronic migraine who:

    • have failed at least three preventive treatments
    • have been appropriately managed for medication overuse headache

    In Scotland, the Scottish Medicines Consortium approved Botox for chronic migraine where people have failed to respond to three oral preventive treatments and any medication overuse has been appropriately managed.

    In Northern Ireland, the Department of Health endorsed the NICE appraisal approving Botox for chronic migraine in 2012.

    How does Botox work?

    Its not clear why Botox is effective in migraine. However, doctors think it works by blocking chemicals called neurotransmitters that carry pain signals from within your brain.

    Will it work for me?

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

    How Much Does Botox Hurt

    People with different pain tolerance -” rel=”nofollow”>different expectations) may answer this question differently. Botox needles hurt as much as any injection would, and the experience is over quickly. Be prepared for it to feel a little uncomfortable, and have an ice pack on hand to soothe inflammation or pain afterward.

    The Verdict: Yes I Would Recommend It

    So far, it’s been a lifesaver for me. Prior to Botox, I’d been experiencing around three or four migraines a week that would have me waving the white flag, and now I’m down to one on average . I also find that my medication works better when I feel one coming on.

    That said, there are a few things I’d make sure everyone knows before trying it. For one thing, it can be pretty painful. I have a pretty high pain tolerance, but getting 30 to 40 shots every three months is pretty rough it feels a bit like getting tattooed with a bee’s stinger, but once the needle is out of your skin, the pain goes away, and if it works for you, it’s worth it. It’s also important to know that it can take some time to work. The first treatment barely worked at all for me, and the second round took a few weeks. If you’re going to try it out, be patient.

    Read more about Botox:

    Will My Insurance Cover Botox Injections For Migraines

    Since Botox is an approved treatment for chronic migraines, many insurance companies will cover some or all of the costs. This includes both Medicare and Medicaid plans. Its important to keep in mind that insurance companies will usually only cover Botox treatments if you have tried and failed two other treatments for your migraines. To verify this, they may ask that you work with your healthcare provider to submit a prior authorization form. 

    Like with any prescription medication, its important to work with your healthcare provider and insurance company to see what cost is covered and what you will be expected to pay out of pocket.

    Challenges To Botox For Migraine

    Several criticisms have been voiced about Botox for chronic migraine.

  • Critics of Botox for chronic migraine have argued that the actual reduction of headache days in terms of reduced headache days greater than placebo is small from the studies. This criticism looks at the total population of patients in the clinical trials which includes both the responders and the non-responders to the treatment. In patients who do respond, there is a significant benefit that is comparable to the most effective migraine preventive treatments.
  • Some have criticized the PREEMPT trial design as focusing on medication overuse headache . Although patients with medication overuse were allowed in the trial, patients whose headaches were escalating and had MOH not MO were excluded. MOH is not the same as MO. The PREEMPT trials did not contain patients with MOH and escalating headaches.
  • Botox is expensive.
  • Side effects included headache, droopy eyelids, neck stiffness & muscle spasm.
  • Other migraine specialists have observed that results from Botox vary. Some patients experience no change at all whilst others experience a very significant reduction in headache days.

    Interestingly, the UKs drug regulatory agency mentioned in its approval that Botox helps avoid the systemic side effects of pills and its safety profile was better overall. 


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