How Does Botox Help Migraines?

Medically reviewed by Mary Choy, PharmD

Botox (onabotulinumtoxinA) is a prescription drug based on the neurotoxin produced by Clostridium botulinum bacteria. It is available in injection form to administer intramuscularly. The Food and Drug Administration (FDA) has approved it to treat several health conditions, including chronic migraines.

Botox has been approved since 2010 in the United States for treating chronic migraines in people aged 18 and over. It is an effective and economical therapeutic approach. 

Chronic migraine (CM) is a neurological disease that impacts an estimated 1% to 2% of the global population. A migraine pain is a severe pulsing or throbbing sensation on one side of the head.

Various other brand and generic forms of onabotulinumtoxinA (OBTA) are available to treat different conditions.

This article will discuss how Botox helps migraines, its mechanism of action, and how to use it.

What Is Botox?

Botox is made from a toxin produced by the Clostridium botulinum bacterium. It was approved by the FDA in 2010 to prevent chronic migraines.

It is a prescription drug used to prevent headaches in people aged 18 years and above with chronic migraines (severe, throbbing headaches occasionally accompanied by nausea and sensitivity to sound or light). Botox is effective for migraine lasting 15 or more days each month, with headaches lasting four hours a day or longer.

Botox is also approved to treat the following conditions:

• Temporary smoothing of facial wrinkles

• Severe underarm sweating

• Cervical dystonia, a neurological disorder causing severe neck and shoulder muscle contractions

• Uncontrollable blinking and misaligned eyes

• Overactive bladder

Various brand and generic forms of onabotulinumtoxinA (OBTA) are available to treat different conditions. Other than Botox, some commonly available botulinum toxin type A brand names include Dysport, Xeomin, and Daxxify, which are available in injection powder for solution. It is also available in BoNT-A, BTA, and botulinum toxin type A generic forms.

Botox is also used for many other indications, including smoothing facial wrinkles, underarm sweating, uncontrollable blinking of the eyes, misaligned eyes, and overactive bladder.

It is used off-label (a medicine used for treating conditions for which FDA does not approve it) for conditions such as:

• Abnormal muscle tightening

• Anal fissures (a tear in the tissue near the rectal area)

• Cerebral palsy (difficulty with movement and balance) in children

• Disorders of the esophagus and larynx, disorders of the nervous system, and many other muscular problems.
  

How Botox Works?

The possible mode of action of Botox in migraine is not fully known. However, the injections work to weaken or paralyze certain muscles or block specific nerves. The effects may last about three to 12 months.

Treating Migraines With Botox

Botulinum toxin type A has been FDA-approved for the treatment of chronic migraine since 2010. It has now become established as a well-tolerated option for the preventive therapy of chronic migraine.

Botox injections deliver neurotoxin into nerve endings at the scalp, neck, and shoulders. It works at the inflamed coverings of the brain and essential neurological pathways to help stop the chronic migraine process and prevent the onset of a migraine.

A healthcare provider will administer Botox injection into 31 key injection sites around the head and neck. A person may request a topical numbing cream to be comfortable during the procedure.

Dosing Botox

The recommended dose for treating chronic migraine is 155 units administered intramuscularly (into the muscle).

Your healthcare provider will administer the prescription dose in divided units into 31 key injection sites around the head and neck.

Repeat the dosing schedule every 12 weeks.

How Quickly Will Botox Work for Migraine?

Botox is effective in managing migraine, but it needs time to work. Some people may feel the benefits within four weeks.

However, it may take up to three treatments to reach efficacy in some people. The treatment is repeated every 12 weeks.

How Effective Is It?

Botox is a low-cost option for the treatment of various kinds of migraines. It is effective at reducing the frequency of migraine attacks per month and lessens the severity of pain.

The safety and effectiveness of Botox have been established globally in more than 5,000 people with chronic migraine in various studies. Across different studies, Botox was well tolerated with fewer side effects during continued treatment cycles.

Another literature review evaluates the effectiveness of Botox and anti-calcitonin gene-related peptide (anti-CGRP) in treating migraine headaches. A comparison shows both anti-CGRP and Botox are effective and safe. However, Botox has fewer side effects, is more cost-efficient, and is easier to use.

Several different preparations of botulinum toxins exist worldwide, which are not identical or interchangeable.

Side Effects

According to various studies, repeated treatment with Botox showed that it is safe and well tolerated. However, it may cause some side effects.

Common Side Effects

Some common side effects include:

• Flu-like symptoms

• Headache

• Upset stomach

• Muscle weakness

• Pain, swelling, and bruising at the injection site

• Temporary drooping eyelids

These side effects usually do not require medical attention.

Severe Side Effects

Some other side effects may include:

• Urinary retention (can't empty bladder completely)

• Urinary tract infection

• Dysuria (painful urination)

• Dysphagia (difficulty in swallowing)

• Back pain

• Rhinitis (nasal congestion, runny nose)

• Increased cough

• Pharyngitis (sore throat)

• Laryngitis

• Axillary (underarm) sweating

Consult your healthcare provider if any of the symptoms do not go away or worsen.

Boxed Warning

Botox comes with a boxed warning (an FDA safety warning) of distant spread to toxin effect that can be life-threatening. It can cause:

• Loss of strength and muscle weakness

• Double or blurred vision

• Drooping eyelids

• Hoarseness and loss of voice

• Trouble speaking clearly

• Loss of bladder control

• Trouble breathing and trouble swallowing

Swallowing and breathing difficulties can be life-threatening, and there have been reports of death. Children and people with preexisting conditions are at greater risk.

Safely Using Botox

You should not use Botox injection if you have the following conditions:

• Are allergic to any of the ingredients in the formulation of Botox

• Allergic to other botulinum toxin products such as Myobloc, Dysport, or Xeomin.

• Skin infection at the planned injection site

• Urinary retention or urinary tract infection (UTI)

Consult your healthcare provider before using Botox if you have any of these problems:

• Breathing problems, such as asthma or emphysema (a chronic lung disease)

• Swallowing problems

• Bleeding disorders

• A previous surgical process on the face or plans to have surgery

• Weakness of the forehead muscles, such as trouble raising the eyebrows or drooping eyelids

• Pregnant or breastfeeding

• Aged above 65 years

Botox injection may cause loss of strength or muscle weakness all over the body or impair vision. Do not drive a car, operate machinery, or do other related activities unless you are assured how the injection has affected you.

Certain groups of drugs can interact with Botox. Talk to your healthcare provider before taking any drug. Some examples include:

• Aminoglycoside antibiotics such as amikacin, Gentak (gentamicin), Tobrex (tobramycin), Lincocin (lincomycin), Cleocin (clindamycin)

• Neuromuscular junction neuromuscular blocking agents (NMBAs), such as Quelicin (succinylcholine)

• Muscle relaxants, Skelaxin (Metaxalone), Vanadom (Carisoprodol) or Flexeril (Cyclobenzaprine) and others

• Other botulinum products, such as Xeomin (incobotulinumtoxinA) and Dysport (abobotulinumtoxinA)

• Anticholinergic drugs, such as generic scopolamine
  

Alternative Options for Migraine Treatment

Migraine is diagnosed based on the person's history using proposed criteria by the International Classification of Headache Disorders 3rd Edition (ICHD-III).

• At least five untreated headache attacks lasting 4 to 72 hours

• Moderate to severe intensity and aggravation by routine physical activities

• Presence of nausea or vomiting with photophobia (light sensitivity)

It is possible to manage migraine and prevent acute attacks. The management is aimed at relieving symptoms and preventing additional attacks. Along with medications, many non-pharmacological means can also sometimes help to relieve pain.

Some tactics to ease symptoms may include:

• Rest or nap with your eyes closed in a quiet and darkened room.

• Place a cold cloth or ice pack on the forehead.

• Drink plenty of fluids, particularly if the migraine is accompanied by vomiting.

• Take small amounts of caffeine during a migraine's early stages.

Avoid the triggers of migraine attacks, including sleep pattern changes, diet, physical activity, stress, anxiety, hormonal changes, and medicines.

In addition, lifestyle modifications such as regular exercise, eating schedule, adequate hydration, and improving sleep patterns can also make a difference.

Non-drug therapy for migraines, such as biofeedback, relaxation training, and acupuncture, can help individuals cope with the body's response to stress.

Summary

Migraine occurs in around 15% of adults and is the seventh most disabling disease among all diseases globally. Botox was approved by the FDA in 2010 as an effective treatment for improving migraine symptoms in people aged 18 and over.

It is a botulinum toxin available in injectable form to treat various conditions. Many other brands of botulinum toxins, such as Daxxify, Desport, and Xeomin, are FDA-approved to treat various conditions. These brands are not interchangeable in any condition.

Botox works effectively by working on nerves and muscles in the head and neck to reduce the episodes of migraine headaches. The treatment cycle continues every 12 weeks. However, it comes with an FDA warning regarding the spread of toxins from injection sites.

Always use as recommended by your healthcare provider.

Frequently Asked Questions

How can I find a healthcare provider who treats migraines with Botox?

If you want to try Botox for migraine, you should consult a headache specialist or neurologist. Your healthcare insurance provider may help you with the listings. You can also look for a specialist at the Botox injection website.

Can I take other anti-migraine medications while using Botox for migraine treatment?

You can continue to take other anti-migraine medications, especially those taken to stop a migraine attack. The Botox label does not specify that people should stop taking aspirin or nonsteroidal anti-inflammatory medications (NSAIDs) such as Advil (ibuprofen) or Aleve (naproxen) before getting the injections. However, some healthcare providers may make that recommendation to reduce bleeding at the injection sites. You can use Tylenol (acetaminophen) as it does not interfere with blood clotting.

Read the original article on Verywell Health.