Dr. Larry Weiss an ENT specialist with over 30 years in practice discusses Botox as a treatment for migraine headaches. What is it? How can it help? Is it right for you?  And how patients who suffer with migraine have seen dramatic improvement in their lives.

Very often patients come in with symptoms of facial pressure, congestion, stuffy nose. And they think that it’s just due to a sinus problem, but very often it is due to migraine, what’s called atypical migraine or migraine variant, which can look very much like a sinus problem. But the cause of migraine is very different than a cause of a sinus problem, and the treatment therefore is very different.

Over the past 30 years, there’s been amazing improvements in the treatment of migraine. The initial medicines that were used often would cause queasiness and nausea themselves, but a recent relative recent option for treatment of migraine is Botox, which was approved by the FDA in 2010. With that said, there’s been over a decade of experience with Botox, and has proven to be very safe, and very importantly, very effective.

Migraines are caused by muscles squeezing specific nerves in our face and scalp, and that squeezing by the muscle triggers the nerve to send impulses to the brain. Botox works by preventing those muscles from squeezing the nerve and eliminates the pathway that triggers migraine. Botox significantly decreases the intensity, duration, and frequency of those suffering from what’s called chronic migraine.

How do we determine if Botox is a proper treatment for an individual suffering from migraine? First of all, we have a lengthy discussion with our patient. Just to make sure that their history fits the criteria for migraine.  Then we perform a specific examination which includes looking inside the nose with an endoscope. And we also examine the nerves that are involved in the migraine pathway.

How do we know if Botox is an appropriate treatment for your specific case?  Well, first of all, there are specific criteria for somebody to be given Botox for migraine. Their migraine has to be considered chronic, which is defined as symptoms that have been going on for at least three months, they happen at least 15 days a month, and they last at least four hours. In addition, the individual has to have been tried on some of the older medications like Imitrex or Sumatriptan and Relpax, sometimes something called Propranolol,  and if that person hasn’t responded, that’s when we will consider Botox for the treatment of their chronic migraine. And, usually, that’s when the insurance companies will actually cover the expense of the Botox.

If the decision is made to proceed with Botox for the treatment of migraine, the individual comes in and we figure out the exact nerves that are involved in that individual’s migraine syndrome. And with the Botox, we’re injecting the muscles that are surrounding those nerves, and what Botox is doing is it prevents those muscles surrounding the nerves from squeezing the nerves, and thereby eliminating the migraine pathway. The procedure takes about 10 minutes and does not require any pain medicine or anesthetic.

One thing to be aware of is that Botox does not work immediately. It usually takes about four days for it to kick in and for the individual to realize the its benefit. It is also not a long-term cure as Botox usually wear off by the 12th week after the initial administration. So for the therapy to continue, it’s necessary to have the treatment repeated once every three months. The vast majority of our patients who have undergone Botox injections see a marked improvement in the quality of their life and do continue. They’re able to focus more on their life and what they want to do rather than having to focus on the significant severe symptoms of migraine.

Botox – will it help your migraine? In summary, it’s essential to get the right diagnosis for what’s causing your symptoms. Is it a sinus problem? Or is it migraine? If migraine, those people who undergo Botox treatment for chronic migraine, recognize a great, great improvement in the quality of their life. For Weiss ENT, I’m doctor Larry Weiss. Thank you.