I've dealt with migraines for almost two decades and, as fellow sufferers know, having a variety of remedies in your toolbox is crucial when pain hits. Enter Botox for migraines, a procedure that despite not being that news, still flies under the radar.
I've typically managed my pain through a combination of medication (both to combat migraines when they hit and to prevent them from happening), home remedies, and a grin-and-bear-it attitude. However, when my migraines increased in both regularity and intensity, I began to research Botox for migraines.
Botox is said to decrease the frequency of migraine days by an average of 50% for those who suffer chronically (people who experience 15 or more headache days per month). So I scheduled an appointment with New York City neurologist and pain-management specialist Dr Risa Ravitz.
She was kind enough to speak with me about the wonders of Botox while we did my first procedure in June 2017. Oculoplastic and ophthalmic surgeon, Dr Elizabeth Hawkes, also spoke to GLAMOUR UK about its benefits, risks and its effectiveness.
As Botox is slowly metabolized in the system, for it to remain effective, patients have to get the procedure every three months or so (however, as Dr Ravitz told me during a recent visit, you can't get it done too frequently or your body will develop antibodies). I've now had four additional rounds of Botox since my initial procedure and have learned a lot about how my body reacts to it. Read on for expert insight and details of my first-hand experience with five rounds of Botox for migraines.
So, what are migraines?
First of all, for those who aren't familiar with migraines, they're different from headaches. Headaches are unpleasant, too, but are typically less severe than migraines and don't usually present with other symptoms besides the pressure and aching in the head. Migraines, on the other hand, can be much more intense and often come with nausea, seeing spots, vomiting, extreme fatigue, sensitivity to light and sound, and more.
Studies have shown they affect 39 million folks in the United States alone, 4 million of whom deal with daily pain, while in the UK, it’s estimated by the NHS that around 10 million people aged between 15 and 69 in the UK suffer with them. Not to mention, the number of admissions to hospitals in England for headaches and migraines has increased by 14% over the last five years.
Dr Hawkes explains that statistics have shown that women are more prone to experiencing migraines. “It’s believed that one reason that women are more susceptible to migraines is because of the fact that they can be triggered by hormone fluctuation," she says. "Women experience hormone fluctuation during their menstrual cycle and also at different periods of their lives such as during pregnancy and menopause.”
Chronic migraines can severely inhibit daily life, and when I started to feel like my bad days were outnumbering my good, I knew I needed to find a solution. Botox had been suggested to me multiple times before by friends, family, and doctors, and though it took quite a while to get it approved by my insurance and find a provider I trusted, my migraines were making it hard to live a normal life, so I decided to try it out.
How is Botox for migraines different from cosmetic Botox?
The Botox used for migraines and the Botox used for cosmetic procedures is actually exactly the same. “Basically, young and middle-aged women were getting [Botox] for cosmetic purposes,” Dr Ravitz tells me. “That's also the most common person that has migraines, and that’s how they figured out it was helpful.”
Women were getting Botox for aesthetic reasons and happened to notice relief from their migraine symptoms, and doctors began looking into it as a direct treatment. In fact, women are disproportionately affected by migraines — about 85 percent of chronic-migraine sufferers are women, and the condition affects 28 million in just the U.S.
The only difference between the two procedures is that with Botox for migraines, they may do a few more shots in areas where the pain is experienced. Personally, I usually get between 30 and 40 shots, concentrated mostly on the right side of my head where the pain occurs, at the base of my skull, and on my neck and shoulders, where I tend to hold tension, as doing so can cause a migraine.
Botox for migraines can have the same aesthetic effect that cosmetic Botox has, which kills two birds with one stone for people who may desire that effect. "We do it along wrinkle lines and keep it symmetrical," says Dr Ravitz, which explains the erasing of lines and temporary plumping of wrinkles.
How does botox for migraines work, and how effective is it?
According to Dr Hawkes, Botox can be an effective way to treat migraines and is approved by the National Institute for Health and Care Excellence (NICE) to do so. “NICE recommends Botox for preventing headaches in adults who have chronic migraines - more than 15 per month - whose condition has not responded to taking at least three prior preventative medications, and has been appropriately managed for medication overuse,” Dr Hawkes explains.
When used to treat migraines, Botox is injected into the scalp, the back of the neck, back of the head, and round the side of head.
So how exactly does it work? Dr Ravitz tells me, "What [Botox] does is paralyse nerve terminals. Essentially, nerve terminals transmit pain, but they also produce pain substances while they’re doing that, and it completely paralyses that process." She says that it stops the process of pain patterning and it also relaxes the muscles.
In Dr Ravitz’s experience, it's very effective among a large sampling of her patients and is usually very well tolerated. She says some of her patients find that it even eliminates the need for medication, which is a huge deal. However, she also says, "About 7 to 10% of my patients find that it’s not effective and they actually feel worse during that time."
As with any medical procedure, everybody (and everyone's actual body) is different and will respond to treatment differently, and it's best to do a healthy amount of research and thoroughly talk to your doctor about your body and medical history before making a decision.
What are the potential side effects?
I asked this question as Dr Ravitz was putting the first needles in my face, which was probably a mistake as I get anxious easily. However, she assured me that the side effects of Botox typically don't happen at the doses prescribed for migraines, and even if the scary-sounding side effects you read about online do occur (such as one-side paralysis and eye droops), they aren't particularly dangerous and last four to six weeks.
"Most commonly, people have pain because you’re dealing with a bunch of shots, and sometimes you can get a headache from the procedure," Dr Ravitz told Allure. "You may have heard about eye droops, but you usually don’t see that. It can happen, but we try to keep it very symmetric so that it doesn’t happen at all."
Personally, I typically experience a headache after the procedure, but I attribute that mostly to tension and anxiety that comes from anticipating pain. It usually goes away before the next morning, and that's the only notable side effect I've experienced in the five rounds of Botox I've had so far.
How long does Botox for migraines last?
Dr Ravitz tells me, "If it’s going to work for a patient, one round of the treatment typically lasts for around three months." Though everybody metabolises it at a different rate, getting Botox every three months or so has been found to be effective.
Dr Hawkes echoes this. "Botox isn’t a total cure for migraines, but it can decrease the frequency and severity of the migraine,” she says, adding: “The NHS can offer multi-site scalp injections of Botox as a treatment to people with headaches persisting for more than 15 days per month. However, whether or not it's offered often depends on your GP.”
What about downtime?
Dr Ravitz says she doesn't think there's any need for downtime unless a patient experiences pain. It can take about two weeks to work, though some patients start to feel relief from chronic migraines sooner than that.
How much does it cost, and does medical insurance cover it?
Botox for migraines can also be expensive. In the US, depending on your insurance, it can cost quite a lot of money — I've changed insurance providers since I first started, and my first provider was around $330 a month and charged me around $1,000 per Botox round (remember, that's four times a year).
My new plan is much more expensive, around $600 a month, but the Botox copay is only $30 each time, so even if Botox is the only medical procedure I need to have done in the year, it made sense to switch.
The last thing I've found to be a little frustrating is that my body tends to metabolise the Botox a bit faster than I can get it. While Dr Ravitz tells me that I can't get the treatment any more frequently than every three months, because that's the rate at which the body can develop antibodies against it, I find my migraines amping up in frequency again about two to two and a half months after I get the shots.
Meanwhile, in the UK, it's possible to access Botox on the NHS and through private healthcare plans. As mentioned previously, Botox is available on the NHS if you suffer from chronic migraines – 15 or more a month – and have tried at least three other preventative treatments. You will be referred to a headache specialist or consultant neurologist who will plan a course of injections with you, however waiting times can vary between nine and 12 months.
For a private course of treatment, it depends on your insurance, so if you’re keen to get botox for your migraines, make sure you’ve checked with your provider first. Bupa Health Insurance, for example, doesn’t cover cosmetic surgery that will alter your appearance, but it does provide cover for chronic health conditions.
The verdict: Yes, I would recommend it
So far, it's been a lifesaver for me. Prior to Botox, I'd been experiencing around three or four migraines a week that would have me waving the white flag, and now I'm down to one on average (and two at most). I also find that my medication works better when I feel one coming on.
That said, there are a few things I'd make sure everyone knows before trying it. For one thing, it can be pretty painful. I have a pretty high pain tolerance, but getting 30 to 40 shots every three months is pretty rough — it feels a bit like getting tattooed with a bee's stinger, but once the needle is out of your skin, the pain goes away, and if it works for you, it's worth it.
It's also important to know that it can take some time to work. The first treatment barely worked at all for me, and the second round took a few weeks. If you're going to try it out, be patient.
