Botox for Migraines

Botox for migraines (onabotulinumtoxinA) is a type of botulinum toxin that may prevent chronic migraines. Your provider may recommend it if you have 15 or more headache days per month.

As the drug name is a mouthful, many people just call it by its brand name, Botox®.

While Botox is widely known for cosmetic use, it has medical benefits, too. It may reduce the number and severity of migraines. You’ll get injections in your head, neck and shoulders every 12 weeks (or as recommended).

Your provider will let you know if this treatment is right for you.

How does Botox help migraines?

Botox works by blocking pain signals before they reach your brain. During a migraine, certain nerves become highly active.

To prevent this, your provider injects Botox into specific muscles in your head, neck and shoulders using a tiny needle. These areas connect to the nerves that send pain signals during a migraine. Botox travels along these connected nerves toward your brainstem. It blocks the release of chemicals that trigger pain.

Botox helps calm any overactive nerves to stop the release of pain signals. This may reduce how often you get a migraine or make symptoms less severe when one happens.

How do I prepare for treatment?

Before your Botox for migraine treatment, you’ll meet with your provider. They’ll explain the risks and benefits and make sure it’s a safe option for you. If you agree to move forward with the treatment, you’ll sign a consent form.

Let your provider know about any medications and supplements you currently take. Botox may interact with different types, like muscle relaxants and sleep medications, for example.

There’s not much that you need to do to prepare. Keep the following in mind on the day of your treatment:

• Make sure you’re wearing comfortable clothes with easy access to your neck and shoulders.
• Don’t wear makeup or be prepared to have it removed at the time of the visit.
• Have pain medicine for a migraine attack ready if you need it.
• Plan for a few hours of quiet time if you feel sore or tired after treatment.

Botox for migraines injection sites

You’ll get 31 small injections in seven different muscles. Your provider will inject them into the following areas:

• Back of your head
• Forehead
• Neck
• Shoulders
• Temples

What happens during a Botox for migraine treatment?

On the day of your treatment, your provider will:

1. Clean your skin with alcohol where they’ll give you injections. This includes areas on your head, neck and shoulders.
2. Make 31 injections into muscles. Your provider will use a very small needle, so you won’t need any anesthesia before the injections.
3. Wipe the injection site clean (removing any blood, which should be very minimal).

Does Botox for migraines hurt?

Most people describe the treatment as a quick pinch or sting. But this really depends on your pain tolerance. The needle that your provider will use is tiny. Keep in mind that they do need to make several pokes in your skin.

Speak up if you’re uncomfortable or if you need a break at any time.

How long does Botox for migraines take?

This treatment usually takes between 15 and 20 minutes. It’s done in your healthcare provider’s office. You don’t need to take off the entire day of work or school for it. You can drive yourself to and from your appointment. It’s recommended that you don’t lie down for four hours after receiving Botox.

Botox for migraines side effects

Side effects of Botox for migraines may include:

• Flu-like symptoms (muscle aches, fever, fatigue)
• Headache
• Mild pain and bruising at the injection site
• Neck pain and stiffness
• Temporary appearance changes (wrinkle reduction, eyebrow arch, etc.)

These are usually minimal and clear up quickly. Let your provider know if you have any severe pain or discomfort.

Benefits of Botox for migraines

The main benefits are that it reduces:

• How severe migraines are
• How long migraines last
• How often migraines happen

Other benefits may include:

• It can be combined with other migraine medications.
• It’s effective with long-term use and has minimal complications.
• The side effects may be better tolerated than other medications available.

What should I avoid after treatment?

To make sure Botox stays where it’s supposed to, don’t do the following after treatment:

• Dye your hair or use chemical treatments (24 hours before or after)
• Lie down (four hours after)
• Exercise or do activities that make you sweat (24 hours after)
• Wash, rub or massage your head, neck or face (24 hours after)

Don’t stop taking your regular migraine medication as prescribed. Your provider will let you know if you need to make changes to your usual migraine medications while participating in Botox injections.

How long will it take for me to feel better?

Botox needs time to start working. You should feel the effects after one to two weeks.

It’s normal for the first two cycles of injections not to offer as much relief. Your body is getting used to it. Your provider may recommend two to three rounds of injections. Then, they’ll check to see how well it works. Your provider will make a follow-up appointment after three rounds to determine your long-term treatment plan.

During your injections, it helps to keep track of your migraine symptoms in a headache diary. You can share this with your provider so they know what’s going on between appointments.

How often do I need Botox injections for migraines?

The effects of Botox typically last between 10 and 12 weeks. You might notice migraine symptoms coming back as you get closer to your next appointment. Your provider may recommend that you get injections every 12 weeks to keep symptoms away.

You may need Botox injections regularly for a few years to manage symptoms. Your provider may space out the timing of your injections or stop treatments if you notice that you don’t have migraine symptoms anymore. Everyone’s treatment plan is different, so your provider will let you know what will work best for your situation.

When should I call my healthcare provider?

Give your provider a call if you have symptoms that don’t improve, like:

• A bad headache
• Droopy eyelids
• Muscle weakness
• Severe injection site pain
• Signs of an allergic reaction, like a rash and itching
• Trouble breathing or swallowing
• Vision changes (like double vision and blurred vision)

Is Botox for migraines safe if I’m pregnant or breastfeeding?

Let your provider know if you’re planning to start a family, pregnant or if you’re breastfeeding. Botox isn’t approved during pregnancy or while breastfeeding. There may be other migraine treatment options to help you during this time. Your provider can help you choose the right one.

Can I get cosmetic Botox with Botox injections for migraines?

Yes, it’s possible. But your provider needs to approve it. Getting too much Botox too close together can cause side effects, or your body might stop responding to it over time. You may need to space out the dates between cosmetic and migraine treatments.