Botox provides small benefit for migraine sufferers
April 24th, 2012
04:01 PM ET

Botox provides small benefit for migraine sufferers

Just a few days after new migraine treatment guidelines were released at the American Academy of Neurology's annual convention, new research published in this week's edition of JAMA, finds Botox may not work as well on migraines as originally thought.

The AAN's recommendations found that numerous drugs, such as the seizure drugs divalproex sodium, sodium valproate and topiramate, along with the beta-blockers metoprolol, propranolol and timolol, are effective for migraine prevention.

The guidelines also noted herbal drugs such as petasites relieved migraine pain and nonsterodial anti-inflammatory drugs, such as ibuprofen and naproxen sodium should be offered to people with migraines to reduce the frequency and severity of attacks.

Botulinum toxin A, otherwise known as Botox, was not mentioned.

Since Botox has become a popular way to eliminate wrinkles in the forehead, doctors have been using it for all types of treatments, from excessive sweating to headaches. But even though the U.S. Food and Drug Administration has approved botulinum toxin A injections for the prevention of chronic migraines, a new analysis finds Botox provides only a small to modest benefit for patients with migraine or daily headaches.

The review states that migraines and tension headaches are extremely common, about 42% of adults in the U.S. experience a tension-type headache sometime in their lives. But many of these headache sufferers don't seek medical help. Migraines are less common - about 8 to 18% of the population suffers from these types of headaches, which are far more debilitating.

Botulinum toxin A injections were first proposed as headache treatments when doctors noticed patients with chronic headaches receiving cosmetic Botox injections also found relief for their headaches. Studies on botulinum effectiveness for headaches have been mixed.

Researchers from the Medical College of Wisconsin, Milwaukee, reviewed previous studies on botulinum toxin A when used for the treatment of migraine, tension or chronic daily headaches in adults. The headaches were categorized as episodic (less than 15 headaches per month) or chronic (15 or more headaches per month), migraine and episodic, or chronic daily or tension headaches.

The researchers reviewed 27 randomized placebo-controlled trials that included a little more than 5,000 study participants and four randomized Botox comparisons with other medications for migraines and chronic headaches.

They found Botox was associated with approximately three fewer headaches per month among patients with chronic daily headaches and among patients with chronic migraine headaches, about two less per month.

There was no significant association between the use of Botox and reduction in the number of episodic migraine or chronic tension-type headaches.

And compared with those on a placebo, Botox caused users to have side effects such as drooping of the upper eyelids, skin tightness, a tingling sensation in the injection area, neck stiffness, muscle weakness and neck pain.

When compared to other drugs, Botox did not prevent chronic migraine headaches any better than drugs like topiramate or amitriptyline.

According to the study authors, "Our analyses suggest that botulinum toxin A may be associated with improvement in the frequency of chronic migraine and chronic daily headaches, but not with improvement in the frequency of episodic migraine, chronic tension-type headaches, or episodic tension-type headaches. However, the association of botulinum toxin A with clinical benefit was small."

soundoff (48 Responses)
  1. Ann Kerry

    I find botox the most effective treatment for my headaches. Much more than the topiramate drug I take, with so many fewer side effects. My headaches are caused by intracranial hypertension (IH), which is relatively rare, but causes severe pain to those who have this condition. There are so many different underlying medical conditions which cause headaches, I'd like to see a study concerning migranes only. Tension headaches and chronic headaches are not necessarily migranes, although they can trigger them. And within the migrane designation there are different types of migranes. I think before we just write off this treatment we need more specific study, and a less dramatic headline!

    April 24, 2012 at 19:54 | Report abuse | Reply
  2. P Singh

    Botox is not effective way for treating migraines considering so many side effects , if you feel knots ( Trigger points) in neck muscles , especially in sub-occipital muscles, Physical Therapist can treat those knots and migraine can be minimized or relieved completely. Quite bit of migraine patient have these knots.

    April 24, 2012 at 20:26 | Report abuse | Reply
    • riley

      I'd prefer the botox side effects than the side effects the other drugs have. Botox works for me in controlling my chronic headaches.

      April 25, 2012 at 14:07 | Report abuse |
    • Nick

      Please tell me what these side effects of Botox are that you speak of? Frankly, it is safer than most other oral treatments if you are looking at side effects. I agree that there is muscle overactivity commonly found concurrently with migraines, but this is not the only mechanism of pain in migraine.

      April 25, 2012 at 23:21 | Report abuse |
    • JRR

      P Singh: No. You are wrong. You must be a physical therapist....I have knots in my shoulders and neck almost constantly. Have been to physical therapy, have done massage. They only work while it's being done. The knots come back. The muscle strain is back. Always. You cannot state emphatically that physical therapy WILL fix the migraines by taking away the knots.

      April 26, 2012 at 08:38 | Report abuse |
    • Natural Botox Alternative

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      May 29, 2012 at 11:54 | Report abuse |
  3. Anonymous

    I have been treated for chronic migraine headaches for close to 8 years now. I have gone on antidepressants known to reduce headaches, tried herbal remedies, and received acupuncture treatments in addition to trying a variety of medicines oriented specifically towards migraine relief. The only treatment I have received that has given me long-term relief is botox. Since I started the injections roughly two years ago, the number of migraines I receive a month has gone down from about 20 to maybe 2 or 3. I respect that this treatment certainly cannot be effective for everyone, but don't let this article discount botox as an option for you if you are a migraine sufferer.

    April 24, 2012 at 20:29 | Report abuse | Reply
    • Barb

      Thank you! Very encouraging! I am also a 15 year chronic migraine sufferer-have tried everything-trying Botox for the first time today. Was getting very discouraged reading until I came across your post. There is hope!

      July 17, 2012 at 07:06 | Report abuse |
  4. medschoolkid

    To those who say botox is the only treatment that works for them, you may honestly be experiencing a placebo effect. If its working and you are getting it from a doctor and not some backroom botox party then there really isn't a reason to stop. Migraines are poorly understood in general. Out of curiosity where is your injection site? I have seen botox injections used as treatments for severe gastric reflux. As long as botox is used correctly it is a fairly safe treatment, but don't forget this is the deadliest neurotoxin ever discovered.

    April 24, 2012 at 23:24 | Report abuse | Reply
    • riley

      Regardless of if its placebo or not for me, my headaches are less. I am glad my dr suggested them.

      April 25, 2012 at 14:08 | Report abuse |
  5. Sunshine

    I have not tried Botox, but I just want to let migraine sufferers know I found a drug over 20 years ago that saved my life and it is: Norvasc 10mg. I take it 1X per day and I went from 20+ migraine headaches p/m to one or two.

    April 25, 2012 at 09:59 | Report abuse | Reply
  6. In the Health Biz

    I know of many kinds of brain issues where botox is very efficient. Migraines come from a large variation of issues, they are not all the same. Botox for 'migraines' is a pretty broad statement actually. I know they are used for brain tremors are treat them very efficiently. There are so many kinds of issues that create migraines and botox is definitely helpful to a lot of patients. I have had patients pay for it out of pocket to fix their migraines just to see if it worked. For some it may not, but I know of several kinds of headaches/migraines that is highly effective for. When botox was finally allowed to be covered by insurance for migraines, brain tremors and other brain issues, I know it helped a lot of people go off their massive amount of medications they were forced to take, most having horrible side effects. . Many of them would never consider it for facial improvements (plastic surgery type). Many of them paid out of their pockets for these treatments just to help get thru life on a daily basis. Each brain issue has different injection points required. I have had several people try sooo many variations of treatments, tons of drugs and the botox eliminates a lot of the hard core medications they would normally take before this was allowed. A lot of the meds come with horrible side effects, or create a non functioning person.

    They are allowing botox for 'anal fissures", which Im afraid to know what that is. There are also a few other medical problems that it helps with. I can honestly say that since its been allowed by the FDA, I know botox injections have minimized a lot of patients medications intake. That has to be a plus!!

    April 25, 2012 at 10:11 | Report abuse | Reply
  7. xeno

    I wonder how they determined who had migraines and who had tension headaches? The term "migraine," to me, has become a very subjective term, one used regularly in the population to describe any bad headache.

    April 25, 2012 at 10:32 | Report abuse | Reply
    • In the Health Biz

      I agree ,it seems to be a common name for patients to use, but each doctor should clearly know the root of their patients migraines, they can show up in MRI's and brain scans as very specific disorders, then the patient just knows it hurts and they call it a migraine to lessen the medical explanation that they most likely dont care to disclose or cant effectively explain it in health terms, hence its a 'migraine'.

      April 25, 2012 at 10:51 | Report abuse |
    • william

      I also agree, those who say they have a migraine truly don't have one. I lose speech, vomit from the pain. 7 years and still trying to solve this riddle. Sumtriptan injection and some marijuana, for nausea, is the only I have found to deal with these horrible, debilitating headaches.

      April 25, 2012 at 22:50 | Report abuse |
  8. EJW

    I haven't seen any improvement by using botox for these severe, debilitating migraines. I think the one's who it does help are extremely lucky that it does help them. Botox must be helping stop their triggers.

    Botox doesn't help the migraines triggered by hormones. Those are quite impossible to treat effectivly.
    Maxalt, sumitriptans help a little but they're not a long term solution. There's little help out there for the vast majority of severe migraine sufferers, besides a fat shot of demerol and well, that's not an ideal long term solution either.

    If botox gets covered under insurance for proven migraine relieve, doctors can bill it at extraordinary costs. Don't tell me they're not giddy about this and would love to push it as an effective treatment. (I've seen this first hand).

    April 25, 2012 at 11:49 | Report abuse | Reply
    • riley

      BCBS covers Botox for my migraines.

      April 25, 2012 at 14:09 | Report abuse |
    • In the Health Biz

      Now that the FDA has approved it for several health issues, ALL insurance carriers are required to cover it. It is not an easy thing to get covered!! You have go thru hell and high water with your doctor by your side to get this achieved. I hate insurance but in their defense (and I would rarely defend them, trust me) the amount of medications that most these people are taking, a shot of botox is nothing compared to the amount of medications it minimizes for the patient. A person I know with brain tremors was taking some of the most expensive medications possible on weekly basis, that didnt even really work. Her botox treatments have minimized her headaches that could last over two days compeltely dibiltating the woman. She can function again without meds. I think its only a matter of time that the price of botox comes down and after 10 years of being on the market, I think generics are able to be made for it, if possible.

      April 26, 2012 at 07:58 | Report abuse |
  9. Ludwig

    Imitrex (sumatriptan) works the best for my migraines. I have been taking it for about two years now, and although there are side effects, I'll take those over the migraines any day. My mother and grandmother suffered for years with debilitating migraines, and I consider it a blessing that we have treatment options available.

    April 25, 2012 at 12:38 | Report abuse | Reply
  10. bencoates57

    BS. The women I know who received Botox for intractable migraines experienced near-total, life-saving relief for 3-4 months. Science obfuscates again!

    April 26, 2012 at 00:55 | Report abuse | Reply
  11. Max Brooks

    I use marijuana whenever I get a headache and it works wonderfully. I know a couple people who have had chronic migraines and regularly medicating with marijuana has been extremely effective for them and as a bonus, they don't need to worry about all the terrible side-effects from other medication.

    April 27, 2012 at 16:32 | Report abuse | Reply
  12. J

    I'm 32 and have had migraines for 17 years. I've gone through EVERY treatment imaginable and had the Botox done last week. In that time, I've had one, relativley mild migraine. As someone who couldn't make it 24 hours without being in crippling pain, it's a total lifesaver for me. Now if only my insurance coverage was decent so I don't have to go into debt.

    May 23, 2012 at 18:10 | Report abuse | Reply
  13. Dr. Serpe

    It has been my clinical experience that very few people experience any long term benefits from Botox injections for migraines. It may be related to my practice focus on the natural treatments of migraine headaches but I would imagine that people don't come to me first. I find that food sensitivities and gastrointestinal inflammation play a large causative role in generating migraines.

    July 10, 2012 at 19:30 | Report abuse | Reply
  14. Krista Ross

    I think for some of us it is very easy to determine we are having migraines. Mine started at about eight years old. I was at softball practice and a huge black hole appeared in my vision, I started slurring my speech, couldn't remember my phone number, what a quarter was to call home (pre-cell phones), couldn't grasp things, my hands started tingling, and I started in a with a blinding headache, and by the time my parents got there, i and had me o the ER I was puking my brains out. That was the beginning of my life with migraines. Now at 30, they have attacked my nervous system, I cannot watch television, or be on a computer for extended periods of time. The flashing lights, and movements, etc, will trigger not only headaches, but the nausea, and the other strange reactions in my body. I have been seeing an awesome neurologist here, and have since learned that migraines that onset prepubescent fall into the broad spectrum of epilepsy. We have tried many things. Topomax, helps a little, but is not turning off my nervous system, or getting rid of the daily headaches. I am a mother of three young boys, and wife to an active duty marine who is on back to back deployments. I desperately want to feel decent. I have never had ten this bad to where they are attacking my whole nervous system. I did find out on my own that dairy is a trigger, and eliminated it. I am not a candidate for any of the beta blockers. i have asthma and low blood pressure. So, I just received my first set of injections from my neurologist two days ago. I am hoping it helps. Desperately hoping it deadens some of these nerves...

    August 6, 2012 at 16:50 | Report abuse | Reply
    • Lemieux

      I have had migraine since age 10. I am now a senior citizen. I started Botox injections 15 yrs. ago. They saved my life, I get Botox every 3 months like clockwork. I still get so-called tension headaches and migraine, but far and few between and they are less severe. Please give the Botox injections a few months to work. The good thing is, I take very few over-the-counter meds. although sometimes I take Amerge or imitrex. The Botox injections are localized and the "toxin" does not enter the bloodstream; therefore it is less harmful than all the other medicines.
      I truly wish you good luck, Lemieux

      August 7, 2012 at 15:32 | Report abuse |
  15. Nan

    I have been taking botox for the past 2 years.botox injection has save my life.this article should not discourage people from trying botox

    August 11, 2012 at 09:36 | Report abuse | Reply
  16. AMS

    I know botox injections are good as anti wrinkle treatment and also for hyperhidrosis which means over perspiration but don't know much about its use in migraine treatment. It is suggested that people over the age of 65 avoid using this treatment or are suffering from Lambert-Eaton syndrome. It is not advised for people taking aminoglycoside antibiotics or have any kind of bleeding disorder also.

    August 24, 2012 at 04:45 | Report abuse | Reply
    • AMS

      Read more about use of Botox for wrinkle treatment at Advance Medical Systems ( http://www.advancemedicalsystems.com/nonlaser/botoxinjection-wrinkletreatment.html )

      August 24, 2012 at 04:51 | Report abuse |
  17. FDA

    I found this post which says FDA approves Botox to treat chronic migraine >> http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229782.htm

    August 24, 2012 at 04:48 | Report abuse | Reply
  18. Kati B

    I too have had near total relief from migraines by getting Dysport (like Botox) injections. Not only did the pain go away, so did the nausea, light sensitivity, nasal congestion... everything. I could start drinking red wine again, and stop wearing dark sunglasses every time I went outside. All with no side effects I noticed.

    The amount and location of the injections has made a huge difference. I've tried several different dosages and locations to test what works (to keep costs down I am trying to find the minimum dose). In my case, I need to have the Dysport right between my eyes, and a little bit at my temples, for it to be 100% effective.

    My guess is that this kind of therapy will have to be customized to each person, just like different medications work differently in each individual. Those who weren't successful may need a different location, amount, etc. But please don't make blanket statements about efficacy when there are so many people who have found relief. These studies may have had the wrong cohort, non-personalized injection points, etc.

    October 1, 2012 at 13:54 | Report abuse | Reply
  19. Devin

    I have been getting mrieaings since I was 17 years old and I am now 41.I have been through so many meds and treatments, as with all of you also. Unfortunately I have a very high tolerance for pain meds so nothing has helped me. The mrieaings have gotten much worse over time. and Over the past few years its hard to remember the last time I have NOT had a migraine, it is a daily thing for me. My neurologist sent me to a Specialist at Yale, and I ended up getting a Opcipital nerve implant, And it has helped where meds haven't. I still do get them all the time since the machine is NOT a cure but a form of pain management, but there are times that the machine actually helps temper down the pain, and as we all know, sometimes that is the greatest relief if there is nothing that helps. Now the pain focuses on my forehead and my Dr. is having me try Botox, insurance actually approved it and hopefully this will help. So desperate for something to work.

    November 16, 2012 at 01:08 | Report abuse | Reply
    • botoxtrainingca

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      April 1, 2014 at 08:07 | Report abuse |
  20. waynemarshalmetadrin

    How long it take to reduce the pain when we use Metadrin?

    October 8, 2013 at 01:32 | Report abuse | Reply
  21. botoxtrainingca

    i think this information is very good and valuable for those people who are suffering from chronic migraine attacks.even if someone wants to know more about botox injections he/she must log on to

    botox drug information

    March 11, 2014 at 06:54 | Report abuse | Reply
  22. Reva Frey

    I keep hearing good things about Las Vegas Botox. I am seriously thinking about getting a treatment.

    March 21, 2014 at 17:55 | Report abuse | Reply
  23. botoxtrainingca

    botox injections are used world wide even there are many side effects of these injections, hope these drugs are good in treating migraine patients.to know more about botox injections click on

    What are the side effect to Botox injection?

    March 26, 2014 at 04:41 | Report abuse | Reply
  24. botoxtrainingca

    Good to hear that botox drugs are helpful in treating migraine attacks for more information on botox drugs click on

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    April 7, 2014 at 23:51 | Report abuse | Reply
  25. RF

    Great article! I have been looking for help choosing a reputable person to give me wrinkle fillers in Las Vegas.

    March 29, 2015 at 23:02 | Report abuse | Reply
  26. mark

    botox is dangerous seriously

    April 12, 2016 at 11:28 | Report abuse | Reply
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  30. Carol Rose

    Botox has taken me from having a headache almost every day to maybe two or three a month. I no longer have to keep rotating the excederin, motrin and alleve. The other treatments are awful. Topamirate, amitriptolyne, the triptans (no idea if I'm spelling those correctly) all made me feel worse. Botox works for chronic migraine! My understanding was that tension headaches are not migraines and episodic migraines are different than chronic. To mix those stats is mixing apples and oranges.

    September 7, 2016 at 13:07 | Report abuse | Reply
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