Botox is a neurotoxin, a poison made by bacteria called Clostridium botulinums. It can cause a deadly reaction called botulism if you eat it in spoiled food because it blocks signals from your nerves and paralyzes your muscles.
But it’s safe because the toxin isn’t digested in your stomach and the dose is much smaller amount than you’d get in spoiled food.
Doctors found that shots of Botox can help smooth wrinkles because it relaxes muscles in the face. It also helps people who have tics and spasms because of a nerve disease like cerebral palsy.
When people who had migraine headaches used Botox to treat their wrinkles, they told their doctors that their headaches were better. So doctors began to study it as a migraine pain treatment.
In a study of adults who get chronic migraine headaches, shots of Botox cut down the total number of days they had them or even other types of headaches. They also had more “crystal-clear” — pain-free — days each month, and they reported fewer days off work.
In another study, nearly half the people who took two rounds of Botox shots reported that the number of days they had a headache each month was cut in half. After five rounds of treatment, that increased to about 70% of the people.
Botox is believed to work for migraine headaches because it blocks chemicals called neurotransmitters that carry pain signals from your brain. Botox is like a roadblock in that pathway. It stops the chemicals before they get to the nerve endings around your head and neck.
Botox is approved for use for the treatment of chronic migraine in adults. Chronic migraine is defined as having at least 15 headache days a month, with at least eight of those featuring migraine symptoms.
It is not an effective treatment for other types of headache including episodic migraine (headache on fewer than 15 days a month), tension-type headache and cluster headache.
Botulinum toxin can be used to treat other conditions such as hemifacial spasm, cervical dystonia, cerebral palsy, bladder pain, lower back pain, neuropathic pain and stroke.
The recommended use of Botox for migraines is limited to people with chronic migraine who:
The guidelines recommend Botox is given as a series of between 31 and 39 small injections. These are given under the skin or into the muscles in and around the head of the forehead, above the ears, and into the neck. The person doing your treatment will have been trained to provide Botox for chronic migraine.
Injections are given every 12 weeks. Botox is usually given until your migraine has changed to episodic migraine for three months in a row, or that there is significant improvement in disability using quality of life questionnaires. If Botox doesn’t improve your migraine enough it may be stopped.
Botox aims to reduce how often you have migraine attacks and how severe they are.
Most people have at least two treatment cycles before deciding if Botox is effective. A good response to Botoxis usually a 30-50% reduction in how many headaches you have. Doctors will also consider any improvements in your quality of life. Some people notice an improvement in their quality of life with Botox even if they don’t have a big reduction in headache days.