Why might you need this treatment?
Botox is generally recommended for patients who have not found relief with oral medications or who cannot tolerate their side effects. It is specifically for those diagnosed with Chronic Migraine, defined as:
- 15 or more headache days per month.
- Headaches that last 4 hours or more per day.
- At least 8 days per month that are clear migraine attacks.
How does the injection help?
Botox works by entering the nerve endings around the injection sites and blocking the release of chemicals (neurotransmitters) that transmit pain signals. The goal is to:
- Reduce the frequency of headache and migraine days.
- Decrease the intensity of attacks when they do occur.
- Improve quality of life by reducing the overall “headache burden.”
What to expect during the procedure
The procedure follows the standardized PREEMPT injection protocol to ensure the best results.
- Location: The injections are performed in a standard office setting.
- Injection Sites: You will receive small injections across seven specific head and neck muscle areas (forehead, temples, back of the head, and upper shoulders).
- Duration: The entire process typically takes about 10 to 15 minutes.
- Sensation: The needle used is very fine; most patients describe the sensation as tiny pinches or stings.
After the procedure
- Recovery: You can typically resume your normal daily activities immediately.
- Precautions: Avoid rubbing or massaging the injection sites for 24 hours to prevent the medication from moving. You should also avoid strenuous exercise or extreme heat (like saunas) for the first day.
- Timeline for Relief: It usually takes 1 to 2 weeks to start feeling the effects. The PREEMPT trials showed that many patients see the most significant improvement after their second or third treatment cycle.
- Frequency: Treatments are typically administered every 12 weeks.
Possible risks and side effects
Botox for migraine is generally well-tolerated, but some patients may experience:
- Neck pain or stiffness (the most common side effect).
- Temporary headache on the day of treatment.
- Eyelid drooping (ptosis) or muscle weakness in the forehead.
- Injection site reactions like minor bruising or swelling.
Important Safety Note: Although extremely rare at the doses used for migraine, there is a “boxed warning” regarding the potential for the toxin to spread beyond the injection site, which can cause breathing or swallowing difficulties. Seek medical attention immediately if you experience these symptoms.
Insurance and Requirements
Most insurance providers require documentation of your headache frequency (often through a headache diary) and proof that you have tried and failed at least two or three other classes of preventive oral medications (such as beta-blockers or anticonvulsants) before approving Botox.
