Botox for Migraines: The Facts
- Megan McCue
- Feb 23
- 3 min read
Updated: Apr 29
Botox has been approved for the prevention of chronic migraines since 2010.
Migraines are considered chronic when they occur 15 or more times in a month.
The protocol for Botox injections for chronic migraines involves injecting 155-195 units, spread across 31 sites around the head and neck.
There are a few theories behind the mechanism of Botox for migraines. The leading one is that botulinum toxin can block the release of certain neurotransmitters/neuromodulators that signal pain to our brains, including substance P and CGRP. (Please note that this means that scientists readily admit that BoNT can and does block multiple other neurotransmitters besides acetylcholine, and thus if it enters your bloodstream and brain via accidental injection into a blood vessel or retrograde axonal transport, you may experience severe central nervous system disruption, including brain fog, seizures, memory loss, photo/phonophobias, and more.)
Per Botox's package insert and Drugs.com, the most common side effects of Botox injections for chronic migraines (occurring in 1-10% of clinical trial patients) include:
-headaches
-migraines
-facial paralysis
-bronchitis
-neck pain
-muscle stiffness
-muscle weakness
-muscle pain
-muscle spasms
Less common symptoms (occurring in .1-1% of clinical trial patients) include:
-dizziness
-dry eyes
-swallowing difficulties
-difficulty breathing
-blurry vision
-anxiety
-heart arrhythmias
-chest tightness
Those of you who are familiar with this website and my books already know the other word for that last set of symptoms: botulism.
Botox's package insert also states: "Severe worsening of migraine requiring hospitalization occurred in approximately 1% of BOTOX treated patients in Study 1 and Study 2, usually withinthe first week after treatment, compared to 0.3% of placebo-treated patients."
Now let's take a look at the clinical trial data on the benefits of Botox for chronic migraines.
Per this systematic review of 28 clinical trials (including 4,190 participants) measuring Botox's efficacy for treatment of chronic migraines, the following results were reported:
"Botulinum toxin treatment resulted in reduced frequency of −2.0 migraine days/month (95% CI −2.8 to −1.1, n=1384) in chronic migraineurs compared with placebo... Botulinum toxin had a relative risk of treatment related adverse events twice that of placebo, but a reduced risk compared with active comparators (other migraine medications)...and a low withdrawal rate (3%)."
Let's break that down.
Receiving Botox for chronic migraines resulted in an average of 2 less days of migraines per month (for folks who have more than 15 migraines per month).
The relative risk of adverse events in the treatment group was TWICE that of the placebo group.
And 3% of folks withdrew from the trials completely
Let's go with the most conservative number and say that your risk of developing botulism (difficulty breathing, swallowing, seeing properly, and surviving life) is .1% with every injection round. You'll need 4 rounds of injections per year for the rest of your life, as Botox does not cure migraines, it only masks your brain's pain signals.
Will most people be ok? Yes. But will some people develop life-altering, long-lasting adverse effects (also known as botulism)? Yes, and I have read through thousands of their stories.
Every single one of them will tell you that the small benefits they got from Botox for their migraines were NOT worth the risk of developing the debilitating, harrowing disease of botulism; a disease that can last for many months, years, or even decades for some, depending on its severity.
I encourage people with migraines to be completely informed of these risks, and to possibly explore different treatment options that do not include a .1-1% chance of developing botulism.
Resources:
Botox package insert:
Drugs.com Botox side effects: https://www.drugs.com/sfx/botox-side-effects.html
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