What to Know If You Are Considering Botox for Migraine

Botox is a drug often used for cosmetic purposes and is FDA approved to treat chronic migraine. Here’s what you need to know if you are thinking about trying Botox.

This year, I turned 34. After first experiencing my typical bout of birthday blues, I decided to give myself a treat: Botox.

I’ve been curious about getting Botox for a few years now, especially with the recent “baby Botox” trend where women in their early 20s get injections to prevent fine lines and wrinkles.

Still, my desire wasn’t solely rooted in vanity. Although, yes, the idea of stopping the clock a little is enticing. For me, even more enticing than treating wrinkles was the idea of potentially treating my migraine attacks.

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Botox for migraine

While Botox is most commonly known for its cosmetic uses, doctors also use it to treat many other conditions, including:

• overactive bladder
• excessive sweating
• chronic migraine

Migraine can either be chronic or episodic. To receive a chronic migraine diagnosis, a person must experience:

• at least 15 headache days per month
• migraine features in at least 8 of those headache episodes
• this pattern for at least 3 months

On the other hand, episodic migraine occurs less frequently and with less severity. Currently, Botox is FDA approved for chronic migraine only.

Other studies show that Botox can be effective in treating tension headaches. In addition, a new clinical trial is in progress, focusing on Botox and episodic migraine.

And people can get Botox for episodic- or tension-type headaches. However, since it’s not FDA approved for those conditions, doctors consider it an off-label treatment, so insurance doesn’t cover it.

How does Botox work?

Botox is an injectable drug that causes temporary muscle paralysis. It contains onabotulinumtoxinA, which blocks the release of a neurotransmitter called acetylcholine, which prevents muscle contraction.

In other words, it forces your muscles to relax.

Stand in front of a mirror and furrow your brow. Do you see those frown lines on your forehead and between your eyes? Those are tiny muscles contracting.

Over time, wrinkles will form there. With Botox, the muscles are unable to contract. So, you can’t see the lines on your face (they’ve relaxed), and you’re not forming new ones.

Botox for migraine works in a similar way. It not only relieves muscle tension but blocks nerve signals involved in pain. A small study in 2018 found that Botox was a safe, effective, and well-tolerated way to treat chronic migraine symptoms.

Can Botox for migraine help with wrinkles too?

Well… maybe.

Technically, it’s the same medication for both purposes. It’s just a different procedure due to where the doctor injects the Botox.

When used cosmetically, Botox injection sites typically include:

• forehead creases
• glabella (in between both eyebrows, commonly known as the “11s”)
• crow’s feet
• upper lip lines
• marionette lines (at the corners of the mouth)
• bunny lines (on the sides of your nose)
• neck

The amount used will vary, depending on how deep your wrinkle lines are. On average, though, you can expect 10 to 30 units (2 to 6 injections) for forehead lines and 10 to 25 units (2 to 5 injections) for glabella.

On the other hand, doctors usually inject Botox for migraine into the:

• procerus muscle in between both eyebrows
• corrugator muscles in the middle of each eyebrow
• forehead
• temples
• neck
• upper back
• back of the head

So, while it won’t address all of your wrinkle concerns, Botox for migraine may help reduce forehead creases.

Doctors also give Botox for migraine to people at a much higher dose. Typically, migraine treatment calls for 155 units, which nets out to 31 injections. However, while the total amount of Botox is higher than cosmetic dosages, each injection consists of 5 units.

This means that, on a per-muscle basis, it’s sometimes less than the dosage used for cosmetic purposes. This is part of the reason why people receiving Botox for chronic migraine often don’t experience the cosmetic effects of the treatment.

Some people also get Botox for TMJ (temporomandibular joint) pain. With this treatment, doctors inject Botox into the temples and masseter muscles. For some, especially those who clench their jaws or grind their teeth at night, this can help with headaches, but it likely won’t impact wrinkles.

What does Botox cost?

The price will vary, depending on where you go and how many injections you have. In general, the cost of Botox treatment for chronic migraine is around $1,700 to $2,300 without insurance.

The effects of Botox are also not permanent, and your body gradually metabolizes the substance. The effects, therefore, usually last only 3 to 4 months. When used for migraine, doctors tend to recommend Botox treatments every 3 months.

Luckily, insurance often covers Botox for chronic migraine as long as you have tried at least two other oral preventive migraine medications previously that did not work for you.

My experience trying cosmetic Botox

Though I get frequent headaches, my migraine attacks are episodic and rarely occur more than 15 days a month. I’ve also only tried one prescription medication (a triptan) and, so far, it’s worked fairly well for me. So, I don’t qualify for Botox for migraine, at least not when it comes to insurance coverage.

Instead, I chose to get Botox injections cosmetically, hoping that it would also help with some of my tension headaches. I ended up getting a total of 30 units (or 6 injections) in my forehead and glabella.

First, the doctor cleansed my face and applied a topical anesthetic cream to minimize pain. She then asked me to do a series of facial movements, raising my eyebrows, frowning, and scrunching my face, before marking my face with a white marker.

After that, it was time for the injections.

The needles used are incredibly small, so the pain was minimal. It felt like a quick, stinging sensation. The strangest part was the sound it made: a crunching noise. Obviously, this caught me off guard, but the doctor explained that it’s normal.

Post-injection, I was instructed to:

• avoid laying down for the first 4 hours after the procedure
• sleep on my back the first night
• take acetaminophen for pain and avoid ibuprofen
• avoid strenuous exercise for at least 24 hours

And that was it! The whole process took less than 30 minutes, including the time it took for her to explain the aftercare.

The Botox itself takes 10 to 14 days to fully kick in, but within 7 days, I saw a noticeable difference. My 11s were completely gone, even when I tried to furrow my brow.

I did, however, get quite a few headaches in those first 2 weeks. That, too, is entirely normal. As you’re adjusting to the effects, you might be trying to forcibly move your facial muscles by scrunching or raising your brows harder than normal, which can cause a headache.

Since then, I’ve been virtually pain and wrinkle free.

The takeaway

It’s important to note that, ironically, one common side effect of Botox is a headache. Many people report getting a headache immediately after Botox, while others say they have mild headaches for the first few weeks.

So, if that happens, don’t get discouraged. Talk with your doctor if you find that your headaches are persistent or worsening or if you experience other side effects like a rash, muscle stiffness or weakness, difficulty swallowing, shortness of breath, or symptoms of an allergic reaction.

Botox can be beneficial for people with chronic migraine, but even if you don’t qualify for treatment, cosmetic Botox may provide some relief for tension headaches.

If you are interested in trying Botox for migraine, it’s always a good idea to speak with your doctor to figure out what treatment you qualify for and if it is the right option for you.