Ask Dr. Clary: How Are Botox Injections Used To Treat Migraine Pain?

Botox injections offer migraine pain relief without the risks or side effects of other migraine treatments.

botox injections

Many medications have been designed to help prevent migraines or provide pain relief. But effective treatment for this ailment remains elusive. Pain medicine specialist Dr. Andrew Clary explains that patients often try five, 10, or even 15 different medications without finding relief from debilitating migraine pain. “Not only does medication effectiveness vary from patient to patient,” says Dr. Clary, “but medications can also come with undesirable side effects. These are just some of the reasons that make data on Botox injections for migraines so exciting.”

Research supports the effectiveness of Botox injections for migraines

Botox has been used to treat migraines for approximately 10 years. “The medication in Botox treats migraines by weakening the facial muscles that cause tension and are believed to trigger headaches and migraines,” Dr. Clary explains. “It’s taken a decade to thoroughly evaluate the effectiveness of Botox for migraines. Now the data has been gathered. The benefits of Botox are clear. That is why migraine treatment is one of the few FDA approved indications for Botox. As a result, these treatments are currently covered by insurance for qualified candidates.”

Multiple benefits of Botox treatment for migraine

Botox injections are good news for migraine sufferers on several fronts.

  • Safety.
    “Botox injections are very safe,” explains Dr. Clary. “Botox is one of the safest procedures I use in my practice.”
  • Convenience.
    “We give Botox injections as an outpatient procedure,” says Dr. Clary. “The patient changes into a gown. We put brief washable marks on the patient’s forehead and potentially near the scalp to guide the injections.”
  • Evidence-based injection guidance.
    “The injection locations are the same for every patient,” Dr. Clary explains. “We target the areas we need to affect, and we know exactly where to put the medication. We do very tiny pinches in those areas, while having a conversation with the patient throughout the procedure.”
  • Few contraindications.
    “Unless a patient has a large skin condition or is injection intolerant, there’s really no contraindication for Botox treatment,” Dr. Clary points out.
  • Lengthy benefit.
    “Often, Botox injections provide migraine relief lasting three to four months,” notes Dr. Clary. “Botox provides pain relief, but won’t take away migraines altogether. Rather, patients can expect migraine frequency and intensity to be lessened significantly.”
  • No restrictions on procedure timing.
    “Patients can actively be in a migraine when they receive the injections,” says Dr. Clary. “Or they can be between migraines. We can also do injections post migraine. And we can repeat the procedure every four months, or as often as you have issues with migraines.”
  • Absence of side effects associated with other migraine medications.
    “The vision changes, tingling, and dry mouth patients experience with other migraine medications don’t exist with Botox,” states Dr. Clary. “And we can offer Botox without asking patients to stop their other medications. In fact, they can continue to take preventative or abortive medications they’ve been on in the past. But if they feel better with the Botox and want to stop taking other medications, they can.”

Restrictions with Botox for migraine treatment

With every treatment option, it is important to consider advantages and disadvantages before making a final decision. Dr. Clary discussed the restrictions inherent with Botox treatment for migraine pain.

  • Botox candidates require preapproval for insurance coverage.
    “Botox has many advantages over other available medication treatments for migraine,” says Dr. Clary. “However, it is the most expensive of currently available treatments. For this reason, insurers want patients to try other available medications before they will approve them for Botox.”
  • Post-procedure restrictions.
    “This is an injection treatment that lays Botox medication just under the skin in precise locations,” says Dr. Clary. “It takes some time for the medication to set up in the muscles and soft tissue areas we target. If pressure is applied to those areas before the medication is absorbed, it could disperse into unintended areas. For this reason, we ask patients not to lie flat for 24 hours following the procedure. They sleep in a chair for the first night. But by the second day, you can go back to your normal sleeping habits.”
  • Limited side effects.
    “Botox reduces wrinkles; an aesthetic side effect patients don’t tend to mind,” smiles Dr. Clary. “However, in rare cases, medication placement has caused patient eyebrows to move slightly lower. This is a very uncommon complication. Even when it does occur, the eyebrows return to their natural position within a few weeks.”

Understanding the risks and benefits of a treatment option helps patients make better-informed choices. “Selecting the right treatment protocol is about considering both medical circumstances and patient preferences,” says Dr. Clary. “Botox injections are a very safe technique and an exciting new treatment option for migraine sufferers.”

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