Botox Therapy For Chronic Migraine: A Neurologist’s Perspective

Dr. Robert Pearlman, neurologist and guest contributor to Family Savvy, offers some helpful information about the use of botox to treat chronic migraines. He shares this information in response to a reader’s question about this subject. In addition to Dr. Pearlman’s advice, more helpful information (including patient Q & A, a downloadable headache diary, and what to expect with botox therapy) can be found on


Botox Therapy For Chronic Migraine

Dr. Robert PearlmanThe current definition of chronic migraine encompasses those patients whose headaches are migranous in nature and occur 15 or more days per month for at least 3 months without other cause (International Headache Society definition). Upwards of 5% of the headache population may have this type of headache. Most of these people will seek medical attention due to the pervasive and disabling effects of severe headaches with the additional symptoms of nausea, vomiting, and light and noise sensitivity. Effective treatment is imperative if patients are to remain active and vibrant in their daily lives.

Over the years, many oral drugs have been tried for chronic migraine with limited effectiveness. In my experience, most patients who suffer from chronic migraine have evolved to that point from episodic migraine. While there are theories that have been proposed for this transformation, most importantly for patients is that it signifies a fundamental change in their headache pattern. By the time a person begins to suffer from chronic migraine, they may have already tried numerous oral prophylactic agents to suppress their headaches. Such medications demand daily use and may be fraught with many side effects.

In 2010, the FDA approved the use of onabotulinum toxin A (Botox) for use in chronic migraine after investigations revealed a therapeutic effect. In the study, patients were given a total of 31 separate 5-unit injections around the head, neck and shoulders for a total dose of 155 units. The results were highly significant for reduction in headache days. Many neurologists, including myself, offer Botox as therapy in the selected patient for chronic migraine.

I view the use of this drug as a valuable tool in the treatment of this disorder that at times has proven vexing to suppress. I like the fact that once injected, patients no longer need to take daily medicine, and if effective, it can be repeated at 3-month intervals.

The side effects are generally few but can include a droopy eyelid and weakness of neck muscles – both of which wear off on their own. Most patients who respond to treatment will sense a change in their headaches by 2 weeks post treatment. While Botox is not a cure for chronic migraine, it has been a welcome relief for some patients from what would otherwise have been daily migraine pain.

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