Beauty is ephemeral, and to extend it people try all kinds of things. And while injections and tucks and cleanses may only prolong good looks for a spell, incidental discoveries along the way many last forever. At least, that’s the case for one effective chronic migraine treatment: botox injections.
In the early 1990s, cosmetic botox was a craze. In Los Angeles, the epicenter of the trend, a plastic surgeon named Dr. William Binder observed a pleasant side effect in his botox patients: headache alleviation. Two decades later, the FDA approved the treatment for migraine, adding it to the toolkit available to physicians treating the condition.
According to those doctors, the treatment often presents a formidable buffer against a constant barrage of pain. “That’s very effective for patients with chronic migraine,” says Dr. Teshamae Monteith, a fellow at the American Academy of Neurology. “And they can be combined with some of these newer treatments or the older treatments.” That is to say, botox can work in conjunction with the newest oral treatments for migraine, where neurologists are seeing exciting scientific progress.
The most cutting-edge iteration of treatment blocks cells' receptors in the brain that cause migraine when they come into contact with a chemical compound called calcitonin gene-related peptide (CGRP), which is released by sensory nerves. As far as experts can tell, botox treatment follows a different tack: by connecting to the nerves themselves and preventing them from releasing CGRP in the first place. "Basically, it blocks painful transmissions into the brain," says Dr. Alina Masters-Israilov, a neurologist at Weill Cornell Medicine. Because the botox approach is distinct from newer therapies going after the CGRP receptors, both can be used in tandem. One treatment blocks the CGRP source, the other blocks its destination.
But botox is just one of a growing list of migraine therapies. Used alone or in tandem with other treatments, what causes doctors to choose it? "It's a great therapy for patients who are having at least 15 days or more headache per month," says Dr. Masters-Israilov. Patients experiencing migraine at that frequency have a condition called chronic migraine. For them, botox often acts as a potent precaution. "It's used really to prevent migraines, or reduce the frequency and the severity of the headache—not really for as-needed treatment."
Dr. Masters-Israilov says that its effectiveness makes botox a relatively frequent choice for patients, especially for those who might not tolerate oral medications well or find other strategies to be ineffective.
For those who do find botox treatment to be effective, there is one side effect—or perk. Because the injection points are typically along the forehead, above the eyebrows, patients "will also get that cosmetic effect where the muscles will be more relaxed," says Dr. Masters-Israilov. “So they won't be able to raise their eyebrows as high or furrow their eyebrows as deeply.”
