Written by: Health & Wellness

Botox Injections for Chronic Migraine Patients

By Josephine Clingan MD

Nothing like a migraine to bring your day to a screeching halt. And we’ve all been there. The pain, nausea/vomiting, sensitivity to light and sound are miserable, but tell-tale signs of a migraine. 5% of the population, with women affected more than men, suffer from this diagnosis. Botulinum toxin injections offer a solution to patients with chronic migraines.

How does botulinum toxin work for migraines?

Botulinum toxin is an injectable protein developed from the bacteria, Clostridium botulinum. There are many brands with Botox, Dysport, and Xeomin, being the top best-known brands. Botox is the only FDA approved botulinum toxin for the treatment of chronic migraines. Botox enters nerve fibers and blocks both the release of neurotransmitters signaling pain to the brain, and pain-producing chemicals.

How often do I need the injections?

Every 90 days, or 3 months, your doctor will perform the injections. These injections follow a specific migraine protocol developed by the PREEMPT clinical trial. In 2010, the FDA approved Botox injections for chronic migraine patients. The protocol consists of 31 injection sites, each with 5 units of toxin. The entire set of injections takes about 10-15 minutes for the doctor to administer and the patient is able to drive home and resume normal activity afterwards.

If no relief after 2-3 sets of injections, the protocol should be terminated and other solutions sought.

Which type of doctor injects botulinum toxin for migraines?

This is typically completed by pain management anesthesiologists, physiatrists, and neurologists.

What are the side effects and risks?

Injections will reduce forehead wrinkles. Botulinum toxin generally takes 3-7 days to reduce the appearance of wrinkles. Aside from bleeding and infection, a risk with any and all injections that is minimized with standard precautions, patients may experience upper eyelid drooping, or ptosis. This will resolve on its own in 6 weeks. Having botulinum toxin injected by an experienced provider will minimize ptosis risks.

Can I have this if I am pregnant?

Very little research has been done to date, but most physicians would prefer to err on the side of caution and postphone injections until delivery.

Does my insurance cover this?

Always check with your doctor and your insurance company, but most commercial insurances and medicare do cover the injections.

Dr. Josephine Clingan is double board certified in anesthesiology and pain medicine in Miami, Florida.

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Tags: , , Last modified: October 4, 2021