There’s some evidence – though studies are mixed – that injections of Botox around the scalp, neck, and face can help some people with migraine headaches.
But scientists are still trying to figure out which patients might be most helped by the injections. So far, the data suggest that people with “imploding” headaches, which feel like the head is being crushed or those who describe their pain as “eye-popping,” may respond better to Botox than people with “exploding” headaches.
Botox (botulinum toxin type A) is approved by the US Food and Drug Administration for crossed eyes, uncontrollable blinking, a certain kind of neck pain, excessive underarm sweating, and for the temporary improvement of frown lines. Some insurers do not pay for Botox for migraines because it is an unapproved use.
Botox works by preventing release of a neurotransmitter called acetylcholine into the space where muscles meet nerves. This causes temporary paralysis.
Whether this is how Botox might work to relieve migraines is unclear, said Dr. David Buchholz, a neurologist at Johns Hopkins University. Buchholz does not use Botox for migraines because injections have to be repeated every few months and the cost is often prohibitive. “It would be thoroughly impractical to consider Botox as an answer for migraine,” he said.
But because Botox has few side effects, Dr. David W. Chen, a neurologist at Massachusetts General Hospital, said it can be a “good alternative” for patients who can’t tolerate other treatment.