Ask Dr. Armstrong: Does Botox help with migraines?

Dr. Armstrong has been prescribing and injecting Botox (onabotulinumtoxinA) since the early 1990’s for muscle tension and for its cosmetic use in reducing wrinkles. In 2010, the U.S. Food and Drug Administration (FDA) approved it for the prevention of chronic migraines in adults. The mechanism by which Botox works to prevent migraines isn’t entirely understood, but several theories and evidence suggest various modes of action:

1. Neurotransmitter Release Inhibition: Botox works by blocking the release of certain neurotransmitters, including acetylcholine, from nerve endings. This action effectively prevents muscle contractions, which is why it’s used for cosmetic purposes to relax facial muscles and reduce wrinkles. For migraines, the blockage of neurotransmitters might prevent the transmission of pain signals in the head and neck.

2. Inhibition of Pain Pathways: It’s believed that Botox may interfere with the transmission of pain signals in the central nervous system. By blocking specific pain pathways, Botox could prevent the onset of migraine episodes.

3. Reduction of Peripheral Sensitization: During a migraine attack, meningeal nociceptors (pain-sensing nerve endings) can become sensitized, amplifying the pain. Botox might help in reducing this peripheral sensitization, thereby decreasing the frequency and severity of migraines.

4. Reduction of Central Sensitization: Chronic migraine sufferers often have heightened sensitivity to stimuli (like light and sound) and might experience pain from ordinarily non-painful events (allodynia). Botox might help in reducing this central sensitization.

5. Effect on Calcitonin Gene-Related Peptide (CGRP): CGRP is a molecule involved in migraine pain pathways. Some studies suggest that Botox might reduce the release of CGRP, thereby mitigating the pain signals associated with migraines.

For migraine treatment, Botox is given approximately every 12 weeks as multiple injections around the head and neck to dull future headache symptoms. It’s vital to have Botox treatments administered by a healthcare professional familiar with the correct injection sites for migraine prevention.

It’s worth noting that Botox might not work for everyone, and it’s primarily recommended for those with chronic migraines (defined as 15 or more headache days a month). As with all medical interventions, potential side effects and individual responses should be discussed with a physician.