Botox for chronic migraines
In this guide, we review the aspects of Botox for chronic migraines, how to get botox for migraines covered by insurance, botox injections for chronic migraines, and where do they inject Botox for migraine?
Botox (botulinum toxin type A) is a type of nerve toxin that paralyses muscles. It comes from a bacterium known as Clostridium botulinum. It was discovered as effective for people with chronic migraine while being used for cosmetics treatment. It was found that people who had Botox experienced fewer headaches.
When is Botox used?
Botox is approved for use on the NHS for the treatment of chronic migraine in adults. Chronic migraine is defined as having at least 15 headache days a month, with at least eight of those featuring migraine symptoms.
It is not an effective treatment for other types of headache including episodic migraine (headache on fewer than 15 days a month), tension-type headache and cluster headache.
Botulinum toxin is used to treat other conditions such as hemifacial spasm, cervical dystonia, cerebral palsy, bladder pain, lower back pain, neuropathic pain and stroke.
In England and Wales, the National Institute of Health and Care Excellence (NICE) recommends the use of Botox for people with chronic migraine who:
- have failed at least three preventive treatments
- have been appropriately managed for medication overuse headache
In Scotland, the Scottish Medicines Consortium (SMC) approved Botox for chronic migraine where people have failed to respond to three oral preventive treatments and any medication overuse has been appropriately managed.
In Northern Ireland, the Department of Health endorsed the NICE appraisal approving Botox for chronic migraine in 2012.
How does Botox work?
It’s not clear why Botox is effective in migraine. However, doctors think it works by blocking chemicals called neurotransmitters that carry pain signals from within your brain.
Botox for chronic migraines
BOTOX® (onabotulinumtoxinA) is a prescription medicine that is injected into muscles and used to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years and older.
It is not known whether BOTOX is safe and effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).
IMPORTANT SAFETY INFORMATION
BOTOX may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX:
- Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are preexisting before injection. Swallowing problems may last for several months.
- Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms, including loss of strength and all-over muscle weakness; double vision; blurred vision; drooping eyelids; hoarseness or change or loss of voice; trouble saying words clearly; loss of bladder control; trouble breathing; and trouble swallowing.
There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX has been used at the recommended dose to treat chronic migraine.
BOTOX may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of receiving BOTOX. If this happens, do not drive a car, operate machinery, or do other dangerous activities.
Do not receive BOTOX if you are allergic to any of the ingredients in BOTOX (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.
The dose of BOTOX is not the same as, or comparable to, another botulinum toxin product.
Serious and/or immediate allergic reactions have been reported, including itching; rash; red, itchy welts; wheezing; asthma symptoms; dizziness; or feeling faint. Get medical help right away if you experience symptoms; further injection of BOTOX should be discontinued.
Tell your doctor about all your muscle or nerve conditions, such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects, including difficulty swallowing and difficulty breathing from typical doses of BOTOX.
Tell your doctor about all your medical conditions, including if you have or have had bleeding problems; have plans to have surgery; had surgery on your face; have weakness of forehead muscles, trouble raising your eyebrows, drooping eyelids, and any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX can harm your unborn baby); are breastfeeding or plan to (it is not known if BOTOX passes into breast milk).
Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using BOTOX with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX in the past.
Tell your doctor if you received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take aspirin-like products or blood thinners.
Other side effects of BOTOX include dry mouth; discomfort or pain at the injection site; tiredness; headache; neck pain; eye problems such as double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes; drooping eyebrows; and upper respiratory tract infection.
how to get botox for migraines covered by insurance
If you’re one of the million Americans who suffer from migraine headaches, you know how debilitating they can be. The American Migraine Foundation reports that migraine affects over 37 million men, women, and children in the United States.
One of the best ways to find relief is through Botox injections. However, you may be wondering: does insurance cover Botox for migraines?
Read on to know more about how Botox can help with migraines and what your insurance coverage may look like.
How Does Botox Work?
Migraines are thought to be caused by overactive nerves. Botox works by temporarily paralyzing the muscles that these nerves supply. It decreases migraine frequency by preventing migraines before they start.
Botox blocks the release of a chemical called acetylcholine. This chemical is responsible for sending signals between nerve cells. By blocking the release of this chemical, botox can help to reduce or even eliminate migraine headaches.
Botox injections are usually given every 12 weeks. The number of injections and the location will depend on the severity of your migraines.
Insurance Coverage For Botox Injections
Most insurance companies will cover at least a portion of the cost of botox injections for migraines. However, coverage may vary depending on your plan. It’s essential to check with your insurance provider to see what is covered under your plan.
Some of the eligibility criteria that insurance companies use to determine coverage for botox injections include:
1) Number of Migraines: You must have a certain number of migraines per month to be eligible for coverage. This number varies depending on the insurance company, but it is typically between eight and twelve migraines per month.
2) Previous Treatment: You may be required to try other treatments for migraines before your insurance company covers botox injections. In some cases, your insurance company may only cover a portion of the cost of botox injections. In this case, you may be responsible for paying the remaining balance out-of-pocket.
3) Patient is Diagnosed With Chronic Headaches: Some insurance companies will only cover botox injections if you have been diagnosed with chronic headaches by a doctor.
4) Persistent Headaches Despite Taking Medication: If you are taking medication for your migraines but are still experiencing a high number of headaches, you may be eligible for coverage.
These medicines include:
a) Anti-seizure medications
b) Antidepressants
c) Beta-blockers
d) Calcium channel blockers
e) Tricyclic antidepressants
For example, antidepressants like amitriptyline and nortriptyline are sometimes used to prevent migraines. If you have tried one or more of these medications and have not experienced relief, you may be eligible for medicaid cover for botox.
botox injections for chronic migraines
Botox is useful to treat and prevent migraine. The full name is Botulinum toxin A.
It is also used to treat a range of conditions such as dystonia, excessive sweating, an overactive bladder, and is used cosmetically.
It is given by injection into specific areas where it causes those muscles to relax but also connects with the nerves in those muscles to help reduce pain.
Any benefit and side effects of Botox are temporary and will wear off completely by 12 weeks. If it is effective, you can usually have it again at 12 weeks.
Who is it for?
Botox is licensed and approved in the UK for people with chronic migraine (at least 15 days of headache a month, eight of which are migraine). Your neurologist or headache specialist will offer this treatment if you have already tried three migraine preventive treatments without them helping to improve your migraine. They will also want to check that you are not using painkillers and triptans too frequently.
What to expect at the clinic
You should bring along your headache diary to the clinic appointment. You should record how many days you have migraine and headache, as well as the number of days (not doses) you use a pain relief treatment.
Many people are understandably anxious about having the 31 injections on their head, neck and shoulders. However, most are surprised at how well they tolerate these very small, superficial injections. The injections are placed with a very fine needle in the forehead, temple area, back of the head, upper neck and shoulders.
The actual injections can be done in 10-15 minutes. However, before the procedure is done, your nurse or doctor will take some time to look at your headache diary, discuss your headache pattern, explain the procedure (including potential benefits and side effects) and allow you time to ask questions.
For most people the injections are done while you are sitting (but you can lie down if preferred or if you feel faint). The injections might be uncomfortable and sting for a few seconds, but this settles quickly.
It is best to come without make-up but the skin will be cleaned prior to the injections, to reduce the chances of infection.
After care
You will be able to return home on your own, but some people prefer to have someone accompany them, especially on the first occasion. It is best to have the rest of the day off, but it is not a requirement to have additional time off following the procedure.
To avoid infection and allow the complete absorption of the drug into the areas injected, it is best to avoid the following during the first 24 hours:
- Vigorous exercise (e.g. gym, jogging)
- Hair washing – you may want to wash your hair the day before the appointment
- Skin cleansing in areas injected
- Massages and extreme heat such as spas
The areas injected might feel bruised or tender for a few days and you may also notice your migraine symptoms are temporarily more severe or you may have a migraine attack in the days following the treatment. You can use your usual acute treatment (e.g. painkillers, triptans) as needed during this period. The benefit will usually develop a week or two after the injections.
Since Botox is given as two separate treatments, three months apart, the full effect might only be felt after the second set of injections. So a lack of effect after the first treatment does not mean that the treatment is not working. Remember to keep a daily headache diary and take this back to the clinic for your next appointment.
Summary of possible side effects:
- A temporary worsening of your migraine for some days or a migraine attack on the day of treatment. These should be treated with your usual medication.
- The skin is cleaned before the injections are done but as with all injections, infection, bleeding, tenderness, and bruising are possible where the injections are placed. This will usually be minor and last no more than a few days.
- Drooping of the eyelid or brow. It is important not to rub the areas where the injections were done for the first 24 hours. Cleaning the forehead, washing the hair, applying make-up is best avoided until the drug is fully absorbed during that first day.
- Minor changes to expression lines in the forehead are possible.
- Weakness and pain in the neck and shoulders which can last a few weeks. If this happens you should let your clinic know and they may avoid injecting those areas in future treatment sessions.
- If you have found no benefit after the second treatment, a third treatment may be given, or an alternative will be considered.
where do they inject Botox for migraine
Botox for Chronic Migraine Overview
Botox, or onabotulinum toxin A, is a drug made from the bacteria Colistridium botulinum. It is well known for its ability to reduce and smooth facial wrinkles, but it can also be an effective treatment for the prevention of chronic migraine. Researchers began exploring Botox for migraine after people who received Botox for cosmetic purposes reported an improvement in their migraine symptoms. Trials were initially designed to evaluate its efficacy in treating episodic migraine, but those studies did not show a significant benefit. Botox was subsequently studied in patients with chronic migraine diagnoses and found to be effective.
Two large studies have been performed evaluating the effectiveness and safety of onabotulinum toxin A. These studies found that Botox significantly reduces the number of headache and migraine days in patients with chronic migraine (defined as having more than 15 headache days per month, with at least eight of them being migraine headaches). These findings led to the approval of Botox injections by the U.S. Food and Drug Administration (FDA) for the treatment of chronic migraine.
MIGRAINE AND HEADACHE SPECIALISTS
What is Botox for chronic migraine used for?
Botox has been approved by the U.S. Food and Drug Administration (FDA) as a preventative treatment for chronic migraine, which is characterized by headaches that occur at least 15 days per month and last four hours or more. Insurance companies usually require people to try at least two other “first-line” preventative medications before they will authorize and approve Botox for chronic migraine.
How does Botox work to treat migraine?
The mechanism by which Botox works to treat migraine is complex. It is thought to function by reducing the release of inflammatory and excitatory neurotransmitters and proteins.
Neurotransmitters are chemicals that the nervous system uses to transmit signals between nerve cells, which are also called neurons. Proteins are large biological molecules that perform important structural, functional, and regulatory functions in your cells.
One of these protein neurotransmitters is calcitonin gene related peptide, or CGRP, which can be elevated in people who are suffering from migraine.
Sensory nerve endings are considered to be overactive in patients with migraine. Botox helps to prevent pain signals from being sent to the brain from the peripheral nerves and is also thought to reduce the activity of CGRP.
CGRP is a target of several other migraine-specific preventive and acute medications.
How is Botox administered?
Botox for chronic migraine consists of 31 injections in the head and neck every 12 weeks. Injection sites include the forehead, temples, back of the head, upper neck, and shoulders. Each treatment takes less than 10 minutes, and the injections are generally well tolerated.
What are the potential side effects of Botox?
One of the most common side effects of Botox is weakness. Because Botox for chronic migraine is injected around the face, head, neck, and shoulders, patients could experience the following side effects:
- Drooping of the eyelid or eyebrow
- Neck weakness
- Shoulder weakness
Avoiding any rubbing of the injection sites for 24 hours can help reduce, but not eliminate, the risk of weakness. If weakness does occur, it tends to be transient and usually resolves within 12 weeks. Other potential side effects include:
- Headache
- Neck pain
- Flu-like symptoms
- Muscle pain
Am I a good candidate for Botox for chronic migraine?
You may be a good candidate for Botox injections if you are an adult suffering from chronic migraine. Botox is not FDA approved for people with migraine who have 14 or fewer headache days per month.
Because Botox can cause serious side effects, it is important to tell your doctor about any other medical conditions you have and any medications you take. You may be at higher risk for serious side effects, such as difficulty swallowing or breathing, if you have neuromuscular conditions such as amyotrophic lateral sclerosis (ALS), myasthenia gravis, or Lambert-Eaton syndrome.
You should not receive Botox injections if you have had an allergic reaction to any botulinum, including:
- Myobloc®(rimabotulinumtoxinB)
- Dysport®(abobotulinumtoxinA)
- Xeomin®(incobotulinumtoxinA)
