Even if you don’t get migraine headaches, you probably know someone who does. Indeed, many of my family members and medical colleagues experience them. However, many of them do not get relief from available medications.

Another Treatment Option

One drug that many patients have found helpful is botulinum toxin A (Botox), a neurotoxin that has been shown to markedly decrease the number and severity of migraines.

Two phase 3 clinical trials—PREEMPT 1 and 2—compared Botox to placebo in preventing migraines among 1,384 patients with chronic migraine. The individual studies, published in Cephalgia in 2010, and the pooled results, published in Headache in 2010, both showed a significant decrease in the number of headache days (per 28 days) with eight to nine fewer headache days at 24 weeks as well as a significant improvement in quality of life in the Botox group.

A long-term efficacy study published in the Journal of Headache Pain in 2018, that followed patients for two years showed similar results.

Despite the evidence, the neurotoxin is still misunderstood by many people who experience migraines. Here are some common misconceptions I hear from patients and how I address them.

MYTH #1: Botox is not approved for chronic migraine.

BUSTED: The US Food and Drug Administration (FDA) approved Botox for the use of chronic migraine in 2010—specifically for patients 18 or older who have 15 or more days of headaches with each episode lasting four or more hours. Even I, a medical student and someone who gets migraine, was not aware of its approval until a few years ago.

MYTH #2: Botox is only for people who experience an intense migraine every day.

BUSTED: People who experience less severe headaches between migraine episodes are still eligible for injections. Patients have to experience a minimum of 15 headaches or more lasting four hours a day or longer per month, according to the FDA.

MYTH #3: Botox works immediately.

BUSTED: The first injection of Botox typically does not provide instant relief. It can take a few weeks or at times months to take full effect. For some people the injection reduces the severity and frequency of attacks; in others it eliminates attacks entirely. Don’t think it isn’t working if you still get a migraine after the first injection.

MYTH #4: Botox overrides triggers.

BUSTED: Some people may find that they are less reactive to their migraine triggers, but typical triggers such as menstruation, stress, poor sleep, and some foods can affect how well Botox works. Each individual’s set of triggers may also change over time, depending on his or her life situation.  

MYTH #5: I don’t have to tell my doctor about my Botox injections for cosmetic purposes.

BUSTED: Botox injections are given every three months. Before getting injections for multiple conditions, including for cosmetic purposes, discuss the risks and benefits with your doctor. If you get Botox injections from any other doctor or health care provider, be sure to inform your neurologist. It’s essential for your safety.

MYTH #6: I never have to take acute medications.

BUSTED: People may still need to take triptans or other acute medications, based on symptoms.

For more information about botulinum toxin A, see our story “Taming a Toxin” in the April/May 2018 issue.

Dr. Satyarthi is a neurologist in training who loves collecting old rare books, enjoys history and traveling, and is interested in health care policy.