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Botox for chronic migraine headaches

Published on April 18, 2018 by

Botox has become a commonplace treatment for the correction of fine lines and facial wrinkles.  In recent years, the uses of Botox has been expanding.  In 2010 the FDA officially approved the use of Botox to treat chronic migraine headaches (defined as having a headache at least 15 days a month).  It is estimated that approximately 3.2 million Americans live with chronic migraine headaches.  Many patients are reporting success in treating their chronic migraine headaches with Botox.    

Botox prevents migraine headaches before they start, but it also takes time to work.  It is injected around the pain fibers involved in the production of headaches.  As Botox enters the nerve endings near the site where it is injected, it blocks the release of chemicals and other neurotransmitters involved in pain pathways.  Most patients see increasing benefit with an increase in the number of treatments, and it can take up to six months to see the maximum benefit from Botox. 

In some instances, insurance plans will cover Botox for the treatment of chronic migraine headaches, although patients usually must have tried and failed to respond to two other preventative treatments.  The number of units may vary between individuals, but the FDA-recommended dosage is 155 units involving 31 injections in seven areas of the head and neck.  Treatments are usually spaced 12 weeks apart. 

The most commonly reported side effect after botox injection for chronic migraine headaches is neck pain.  Other adverse effects may include focal pain at the injection sites, unwanted muscle weakness, blurry vision, dry mouth, swallowing difficulties, and some patients even report diffuse fatigue. Most of these adverse effects improve or resolve within the first 7 to 10 days after injections.

Although it is difficult to predict who exactly will respond to treatment, typically those who are going to respond will note some improvement in headaches following the first set of injections.  Although not everyone is going to respond to Botox treatment, it can be effective in certain individuals in alleviating the symptoms and/or frequency of chronic migraine headaches. 

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