Spotlight on the FDA: Does Botox Work for Chronic Migraine?

March 9, 2017

What’s Botox?
If you’ve heard of Botox, it was likely in the context of beauty and cosmetics. This treatment, which usually involves injections to the face and head, is most often employed as a means of smoothing out wrinkles and crow’s feet and tightening the skin. For those who’ve used this to enhance their appearance, they swear by it. Unlike many treatments and creams for “younger-looking” skin, this approach seems very successful.

Developed in the late 1990s and popularized in the early 2000s, it was more recently found that Botox isn’t merely a beauty aid. In 2010, the Food and Drug Administration (FDA) approved Botox treatment for cases of chronic migraine, where headaches last at least 15 days a month [1]. Getting FDA approval is no small task—treatments need to be well-supported by evidence and pass-repeated trials—so these injections are safely vetted.

How Does it Work?
Botox is short for “botulinum toxin type A,” which is a drug derived from the bacteria that causes food poisoning. While it would make you sick if you ate it, it has a different effect when encountering tissues in the body. When injected, Botox causes a temporary paralysis of nerves and muscles, creating a smoother skin from lack of nerve activity. Treatments, both for medical and beauty purposes, need to be repeated every three months.

Healing Under The Skin
But how would this work for chronic migraine? As to what it is about Botox that makes it effective, it’s still not fully understood. One recent study found evidence that it reduced expression of pain pathways in the trigeminal nerve system [2]. This brain system is heavily involved in sensation and perception and is thought to be the source of many migraine problems. When its activity is slowed, it’s theorized, migraine attacks become less frequent and severe.

What Happens
During the procedure, the doctor injects the solution into specific areas of the body, including the bridge of the nose, the temples, forehead, back of the head, neck, and upper back [1]. Effects aren’t felt immediately, but, usually, within 10 to 14 days, there’s a marked reduction in frequency and duration of headaches.

Weighing the Evidence
Botox for migraine sounds promising, but it’s important to look at what the research says about it. Probably the most wide-ranging and extensive work was done by Dr. Hans Diener and his team at the University of Essen in Germany, in 2010. Conducting what was dubbed the “PREEMPT” trial, the researchers randomized 1,384 chronic migraine patients between those who were getting treatment and those who received a placebo [3]. Treatment was done every 12 weeks over the course of 14 months.

What did Dr. Diener and his colleagues find? Here’s a quick breakdown:

  • At Six Months: As compared to the placebo group, those who received Botox had on average of eight fewer headaches a month after two cycles of treatment.
  • After One Year: 70% of participants who had Botox injections reported at least a 50% reduction in the amount of headaches per month.
  • Well-Tolerated: The researchers also noted that the treatment was well-tolerated and had few side-effects: 6.7% reported neck pain; 5.5% felt some muscular weakness, and 3.3% noted drooping of the eyelid.

Is Botox Right for Me?
With a condition as debilitating and unpredictable as migraine, there are any number of approaches that a person may try. Since the reasons people suffer from migraine attacks or develop chronic problems are not fully understood, individual treatment often becomes a matter of trial and error. In this sense, it is worth asking your doctor about Botox for chronic migraine, especially when other approaches aren’t working.

Ultimately, it’s important to remember that, while there is no one-size-fits-all solution to chronic migraine, more and more procedures and approaches are being developed. As doctors and researchers get a better understanding of what’s at the root of this condition, treatment will only become more effective.

To learn about treatment approaches to chronic migraine, talk to a Patient Care Manager at Migraine Treatment Centers of America. Bringing together some of the true leaders in the field with some of the latest advances in technology, this team has helped countless migraineurs find effective relief. Call them at (855) 300-6822 today!  


  1. Holland, K. (2017). Does Botox Help Treat Chronic Migraine?. [online] Healthline. Available at: [Accessed 8 Mar. 2017].
  2. “Botox – The Migraine Trust”. 2017. The Migraine Trust. Accessed March 8 2017.
  3. Diener, H., Dodick, D., Aurora, S., Turkel, C., DeGryse, R., Lipton, R., Silberstein, S. and Brin, M. (2010). OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia, 30(7), pp.804-814.


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