Botox for Migraine – how does it actually work?

Botox, or onabotulinumtoxinA, is an emerging and at times controversial treatment for migraine.  Many patients have found relief through Botox treatment, although others have found that it wasn’t very helpful for them.  Par for the course when it comes to migraine treatment.

But just why does Botox help – at least some patients?

The most obvious answer seems to be the way it relaxes muscles.  Certainly if tense muscles were triggering migraine attacks, or if they were a part of the chain-reaction or vicious-cycle of migraine, we would expect to see some relief if those muscles were relaxed.

And that still could be part of the answer.

But the pain of migraine (in fact, even the pain of tension-type headaches), does not come from muscle tension.  Sure, it could be a part of the cycle, but is that really enough to explain the relief that many get from Botox?

Dr. Alexander Mauskop from the New York Headache Clinic writes about his observations:

I have seen some patients who would report that injecting muscles around the head eliminated pain in the injected areas, but that they still had pain on the top of the head.  There are no muscles on the top of the head and we usually do not inject Botox there, but in those patients who do have residual pain on the top, injecting Botox stops the pain.  Recent research has shown that Botox in fact also exerts a direct analgesic (pain-relieving) effect.  This is supported by my and other doctors’ observation that Botox also helps other types of pain, such as that of shingles or trigeminal neuralgia.

He goes on to point out that we need some solid studies to confirm what many doctors and patients are seeing.

He finishes by saying that Botox seems to help by reducing the pain messages that are being sent to the brain.  Without the flurry of pain messages to the brain, the migraine chain reaction can’t begin.  In fact, some patients report that, after Botox treatment, they sometimes feel like a migraine is about to start, but it never does.

If you’ve had Botox treatment, how does this compare with your experience?  Leave a comment!

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30 comments… add one
  • helen Feb 17, 2012

    I get Botox injections every 3 months. I usually do not have any kind of headache when i have the treatments so for me it is more of a preventative treatment than an acute treatment. I think it is effective. I have had fewer headaches since I have been getting Botox treatments and they are less severe. I think Dr. Mauskopf’s theory is plausible.

  • Elaine Feb 19, 2012

    My neurologist told me with each treatment results should improve. I sure do hope so. So far I’m still having more that 15 migraines a month. It has decreased the severity of the pain, especially in the occipital area, and neck. The other symptoms: numbness, tingling, nausea, aura, phantom smells, tiredness, sensitivity to light & sound continue to bother me. The pain level varies from a 3 to 6, occasionally it has been more, but rarely so. So for pain it has been a definite improvement.

  • Melissa Feb 21, 2012

    I’ve suffered from migraines since childhood. I’ve had chronic migraines for several years. I’ve tried every preventive medication and they either did not work or I could not tolerate the side effects at an effective dose. My new neurologist suggested botox. I have had one treatment. Initially I was discouraged because I did not have relief, but within a couple of weeks I felt the same as others have reported. I would feel like a migraine was starting, but like it was blocked. After about 5-6 weeks I noticed that I was no longer in constant pain and have only had an occassional migraine since that was easily resolved with acute medication. Previously I almost always had some level of pain. This is a huge improvement for me.

  • Alexis Feb 22, 2012

    I am in the middle of my first set of injections and am really pleased with the results. I have seen a dramatic drop in the amount of intervention medicines I need to take (Maxalt or Frova). Mine aren’t gone. However, I can honestly say for the first time in years I have many more better days than headache days. Thrilled and looking forward to more improvement. 🙂

  • Veronika Feb 27, 2012

    The relation between migraine and the use of botox injection is not yet proven true yet nor being endorse by recognized groups.

    Ironically, the adverse reaction that was noted by the FDA with the use of Botox as a migraine treatment includes headache and neck pain. They even assigned a box warning in the packaging which states that the toxin could spread out of the treated site, and could create a reaction similar to food poisoning. Therefore it is very important that you get the injection from a certified physician.

  • Angelette Mar 4, 2012

    I started having migraines when I was 8 and I’m now 40. The chronic migraines started a little over a year ago
    I’ve had 2 rounds of Botox. One in November one in January. It has been slightly helpful with neck pain but I’m still getting migraines almost daily. I will say I’m getting better relief when I take a Triptan and naproxen now since the Botox treatments but it has not been a cure all.

  • Mark Mar 17, 2012

    I too have had headaches all of my life. I remember taking aspirin and rolling around in bed as a young child praying for the pain to go away. They just became more numerous as I got older, now in my fifties I barely had a good day at all, I just felt I had no choice but to deal with it the best I can. Three days ago I tried the Botox in my temples, and the back of my head, is this the miracle I’ve been seeking, because so far, not any pain at all! I’m optimistic now for an insanely long time that I might get to feel like a normal person gets to feel, what an incredible thing that would be! My best wishes go out to everone who suffers, I hope we all find an answer to our misery..

  • Barbara Mar 21, 2012

    I have suffered from migraines for 27 years now. I get 15 migraines a month. I’m on the Sumatriptan Injections (needle free) & Topamax On February 9, 2012 I received the Botox injection in-between my eye brows, hairline, shoulder, neck and back of my skull. Two days after Botox I got a migraine. Next Migraine not until February 25, 2012 I had that migraine till February 28, 2012. Next Migraine March 7, 2012. Next Migraine March 12, 2012 till March 13, 2012. Next Migraine March 18, 2012. Per my neurologist I couldn’t report in till mid March, that would give the Botox time to work. I have noticed blurred vision and a loss for words in the last two weeks. I know what I want to say but my tongue get’s frozen or has trouble sayings it. I’m happy the number of migraines has decreased but the blurred vision has frighten me and the loss of words has me scared. I have an appt. with my doctor to discuss this. I hope if you have gotten Botox you are not having blurred vision or a loss for words, you are having great results!!

    • Elaine Mar 22, 2012

      Barbara, I have problems finding words, being at a loss of words, knowing what I want to say, but it just doesn’t come. I’ve been told that’s from the Topamax, sometimes referred to as “Dopamax”. I can’t speak to the blurred vision. I would definitely get that checked out. I do have symptoms that pop up now and then that are new to me, but I don’t think they relate to the Botox. I think it’s just Migraine. I go next month for my third round of injections. Last week I had five days straight with no migraine. That’s amazing for me. I hope it keeps getting better. I hope so for you too!

    • Betsy Feb 21, 2013

      The loss of words is exactly why I quit Topamax treatment – although it was quite effective for my migraines. But when I blew a job interview because of that effect – I couldn’t get the words I wanted to say to come out of my mouth – and ended up looking pretty much like an idiot when applying for an advanced professional job, I realized that the improvement in the migraines wasn’t worth not being able to work to my potential. So you probably want to talk to your neuro about the Topamax dose – that effect isn’t from the Botox.

    • ChristinaLCM Jun 24, 2015

      I’ve lived with chronic migraines my entire life. My mother (who also suffers), first noticed me shying from light and noise trying to cover my eyes and ears before I was a year old. I do not know what being without the pain is like for extended period. With regard to symptoms that cause your brain to process more slowly… Occasionally I have them. I will slur my words, (I have been afraid of being pulled over and arrested as a drunk), they come with tunneled or blackened vision and severe light sensitivity and nausea often with vomiting. I have been on Topamax – yes, Dopamax is appropriate – although for me, I have more trouble simply staying awake (historically on this drug) than having it make my thoughts muzzy. Migraine pain does that well enough to make a fool of the brightest of us.

  • Leonardo Apr 29, 2012

    Hello All I am 24 years old man and last 4 years are awfull to me I have daily headattache my neurologist’s say it maybe is cluster or migraine or tensions headattache they are not sure for my diagnoses because the sipmptoms are different.I try it couple medications like antidepresant and beta blockers but nothing help me I feel very strong pressure around my head after that muscle spasms and after that pain, now I want to try with botox but I am not so sure it will be helpfull for me for my headattache i dont know what to do???????

  • Maureen May 17, 2012

    The severity of my migraines has increased from 1day to 2 and now up to 3 days at a time, Usually 2-3 times a month.
    I had my first botox injection (forehead only) and had relief for 3 months. Had my 2nd injection and so far no migraine for 4 weeks.
    Have to pay out of my own pocket, but IT IS WORTH IT! Planning to continue as long as there is relief.

  • Julie Oct 22, 2012

    I have only had one set of Botox shots, but feel that it has helped most of the bad spasms in my neck, trapezius and part of my head. I still get the migraines, but they are soooo much easier to deal with, which means a better quality of life. I would always get very bad headaches the day after strenuous exercise and now have minimal pain the next day. Thankful for Botox!

  • Laura K Nov 25, 2012

    I live in the UK and will head to the National Migraine Clinic in London in a couple of weeks for my third round of Botox. I was getting 15-19 migraines a month before the botox (I took a beta-blocker and magnesium, CO-Q10, B2 supplements as prophylactics, along with Relpax as needed). After about a month after the first treatment (33 shots to the head, neck, shoulders), the headache incidence dropped to 9 per month. I also noticed my triptan seemed to be more effective and the neck and scalp soreness was greatly improved. I’ve had a worse month or two after my second treatment (we added some shots to the top of my head, as I still have pain there), but still only 9-11 per month instead of 18, which is great. My neurologist and I are hoping with continued treatment every 12 weeks, I’ll see increased improvement. I’ve stopped the beta-blocker since it really didn’t seem to be helping. The Botox definitely helped my pain. It costs me 500 pounds here in the UK for each treatment, which is cheaper than in the US, apparently. I hope I can continue the treatments when I return to the states.

  • Cat Dec 14, 2012

    3 series of botox injections since last June……won’t do it again because I have had little to no relief in chronic daily headaches

  • Andrea Gehrke Dec 14, 2012

    I can’t begin to tell you how guilty I feel that botox was not my friend. In fact, it made my migraines worse the first few weeks of each of the two sessions I had because my neck became stiff. Compounding my guilt was my pcp acting surprised when I told her botox didn’t work, and she said “all my other patients who have tried it had great results”. I’ve had migraines since I was 22 and they became chronic in 1991. Have tried so many things including three different drug holidays, acupuncture & chiropractic manipulation/therapy. Would like to try neuro stimulation, but my neuro hasn’t even heard of it! Very frustrating.

  • Patti Dec 14, 2012

    I have had horrific migraine for 49 yrs. I averaged between 15 and 20 per month. I have been receiving Botox for migraine every 3 months for the last 4 yrs. I don’t understand how it works but I can report that they are greatly reduced. When I have Botox, I do not get the vomiting migraines that make me think I am having a stroke. I still get migraines – about 3-5 per month but nothing nearly as horrific. If I miss getting my Botox injections by even a couple of weeks, the vomiting migraines return. It’s pure magic.

  • Elaine Axten Dec 15, 2012

    I am in the UK too, and go to the National Migraine Centre. My neuro, Giles Elrington, probably the leading practitioner in the UK says the effectiveness of the Botox USED to be thought to be about muscles, but it is now known to be about nerves. they still call the sites of injection by the muscular names, but it is now a misnomer to do so.
    Last time round i had complete relief, but this time not so much, but i am fairly convinced i know why – I am altering doses of a drug that has an estrogenic effect, so I am effectively having period migraines, which even triptans don’t touch. I expect to feel somewhat better when I am steady on the medication.
    Last time I went, he also showed me some very interesting data involving the effectiveness of the treatment comparing people who used opiates and people who used triptans. For some reason those who use codeine seem to get significantly less out of treatment than those who use triptans, so that’s something to think about if you are going for Botox treatment.

  • Glenn Dec 17, 2012

    I just turned 59, and have gotten common migraines since the youngest age I remember. They are horrendous. I have a severe hearing loss now, possibly from the massive amounts of aspirin I took all my life to survive these events. I got botox from a dermatologist about a year ago. It didn’t help. Sometimes when I’m collapsed in a heap with a migraine, my wife would come up behind me and knead my neck and shoulder muscles to help me. She told me that when I have a migraine, my neck muscles are like a rock. After botox, she said my neck muscles were relaxed, while I had my migraine.
    For help, I just take imitrex. A quarter of a tab, 25 mg, seems to help me. I will stick with that and be careful what I eat. Something very interesting I’ve realized about my diet… I can eat meat and it’s ok. I can eat a dessert and it’s ok. But at the same meal, I could be in a lot of trouble for days. I don’t know why. So I figured out the ‘bad’ combinations for me. and avoid them.

  • Susan Dec 17, 2012

    Just completed my second round of Botox (self-paid), and while I do have a headache for a few days after the injections, they are not migraines. I have not had a migraine for 4 months. SO glad I decided to try it.

  • Julie Dec 17, 2012

    I was having migraines every time I exercised or exerted myself and when I had my periods. This was much of the time, but since botox injections, I am 99% headache free. Maybe I should say pain free, because sometimes I do feel like I am getting a migraine, but don’t get the pain. After years of these headaches, it is short of a miracle. Of note, I also take protryptoline (anti-depressant) that has helped get the migraines down to just the exercise and menses, but the botox took away the remaining headaches. I truly thank God for these meds and for Dr. Shchelkov!

  • Betsy Feb 21, 2013

    Botox injections have been relatively successful for me as a preventative treatment – certainly moreso than the 3 typewritten pages of everything else I’ve tried! I went from daily migraines for a period of 6 months down to maybe 12 migraine days per month now – still a lot, but a significant decrease for me. I’m on my third round of injections (I go roughly every 4-5 months) and until my neuro upped my total injection dose to 200 units (from 100), it wasn’t effective. YMMV depending on YOUR migraines and how you react.

  • Judy Jun 1, 2015

    Didn’t really help a lot for me so I went for acupunture , I swear by it helped tremendous

  • Kayleen Jun 1, 2015

    Two rounds of Botox and I got significantly worse.

  • Mimi Jul 28, 2015

    I started Botox injections about two years ago. First set helped for two weeks. Second set helped for a month and each set got better and better results: fewer migraines, no more throwing up, no hiding under the sheets. I still got around 8 migraines a month but zomig helped. But for the last two rounds, I’m back to 15-20 per month. I see the neurologist soon and we might not do them anymore. Being 65, I’m concerned about the side effects of the zomig on my heart. No preventatives work. I’m very disappointed that the Botox is not as effective as it was.

  • Lisa Jun 17, 2016

    I just got my first injection. But, I do not just have migraines, I have a condition called Idiopathic Intracranial Hypertension. And my neuro ophthalmologist I have to see for the rest of my life said it was ok to go with. But he had just recently gotten my headaches and migraines down, by Diamox and Topamax. So I am going to give it a chance, because it said something about relaxing the muscles in the injection sites. And I do know that my neck muscles and shoulder muscles are always tight. Any suggestions, encouragements, advice.

  • Amber Feb 26, 2017

    Did first set of Botox in December
    Go back march 29th
    Thus far I go to bed w migraine and wake with them
    I have 3 kids and it’s so depressing to feel this way daily. I also have not had success w decent doctors and have advocated myself and try everything u can imagine
    Doctors want me to try the 2nd set –
    I don’t know if I want to being I have had NO relief thus far from 1st set
    I don’t know what to do
    Husband wants to take me to Mayo Clinic @ this point

  • Laura Krome Mar 8, 2017

    My doc had me try at least 3 rounds before deciding. I went for 2 years. I did see a reduction in pain and in between headache pain. My incidence did not improve though, so I quit. I now do Allevio SPG blocks every 3 weeks and take duloxetine daily. This has helped some. If I were you, I would try at least one more round. And look into Allevio.

  • Glenn Mar 10, 2017

    Amber, I go to an NMD now. She had me get genetically tested. The alleles show what foods to avoid. What supplements I should be taking. She’s a big help.

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