Can Cosmetic Botox Help Migraines? - 2023, Gabriela Margall

Can Cosmetic Botox Help Migraines
DEAR MAYO CLINIC: I have suffered with migraines on and off for about five years. Recently, the oral therapy I’ve used seems to be less effective. While I know newer medications are available, a friend suggested I try Botox injections. She swears it brought her chronic headaches under control.

How safe are these injections, and how does Botox work? What is the treatment schedule, and would I also need to be on other headache medication, too? ANSWER: Onabotulinum toxin A, or Botox, was approved by the Food and Drug Administration in 2010 to treat chronic migraine headaches, It is not a cure.

People who receive Botox injections for headaches usually get the treatment about every three months. For some, that is all they need to keep their headaches under control. For others, additional medication or other headache therapy is necessary. Research is ongoing about new forms of migraine therapy.

Botox is a medication that uses a form of botulinum toxin to temporarily paralyze muscle activity. Best known for its ability to reduce the appearance of facial wrinkles, Botox also has been shown to prevent chronic migraine headaches in some people. It is used mainly for those who have headaches 15 or more days per month.

Since 2002, doctors at Mayo Clinic have treated thousands of patients with chronic migraine effectively and safely using Botox. The medication typically is injected into muscles of the forehead, scalp, neck and shoulders. The specific details of how Botox works to prevent headaches are not known.

But it is likely that the injected Botox is taken up by pain receptors in the muscles’ nerves. The medication then deactivates those pain receptors and blocks pain signals that the nerves send to the brain. The pain does not go away permanently, however. After several months, the nerves sprout new pain fibers, and the headaches tend to return.

The Botox effect usually lasts about 2½ months. Because injections are repeated no sooner than every three months, some people need other headache treatments for the last two weeks of a Botox cycle. Providing Botox treatment for headaches every three months is a national standard, as recommended by the American Headache Society.

The treatments are not given more often due to a small possibility that if you receive Botox more frequently, your body might build up antibodies to botulinum toxin.
Those antibodies could in theory prevent Botox from working with future injections.
For many people, treatment with Botox alone is sufficient to control their chronic headaches. However, some people require more care, including additional medications to prevent migraine attacks.

These may include cardiovascular drugs, such as beta blockers and calcium channel blockers; certain antidepressants; and some anti-seizure medications. Medications taken at the time of a migraine headache also can be useful. The most common side effects of Botox injection include swelling or bruising at the injection site.

Uncommonly, the medication may spread into nearby tissues and cause problems, such as a drooping eyelid, eyebrows that look out of place, dry eyes or excessive eye tearing. This tends to happen more in people who already have some eye drooping or are more sensitive to botulinum toxin. Sometimes, changing the injections to a slightly different location can reduce this side effect.

Although rare, it is possible that the effect of botulinum toxin may spread to other parts of the body and cause symptoms such as muscle weakness, vision problems, trouble speaking or swallowing, or difficulty breathing. Doctors generally recommend against using Botox if you are pregnant or breastfeeding because the medication’s effects on a fetus are not known.

Botox injections are expensive. They can cost several thousand dollars per set of injections. Many insurance companies will cover the injections if a patient meets criteria for chronic migraine headache. For at least three months, a person must have a headache occurring on 15 or more days per month that has the features of a migraine on at least eight days per month.

It is best to speak to a health care professional about options. Before moving forward with Botox injections, make sure you are under the care of a licensed and skilled health care professional. Botox can be dangerous if it is given incorrectly, so it is important that these injections be administered by a physician, nurse or another specialist with experience using them for chronic headaches.

Minnesota man takes shot at getting his voice back published 8/17/22 Mayo Clinic Q and A: Treatment options for migraine published 8/7/22 Mayo Clinic expert offers tips to prevent, manage headaches, from migraine to ‘rebound’ published 6/8/22 ‘SEEDS’ for success in migraine management published 11/18/21 Science Saturday: Opioids provide low evidence of pain relief for migraine published 8/28/21 Mayo Clinic Minute: Can weather trigger migraines? published 6/22/21 Consumer Health: Understanding migraine headaches published 6/1/21

Can Botox Cosmetic be used for migraines?

Head and Neck Plastic and Reconstructive Surgery Headache Featured Expert: Wrinkle-reducing treatments that use botulinum toxin injectables may also be used to treat chronic migraines. These treatments, known as neuromodulating drugs (such as Botox, Dysport, Xeomin and Mybloc), were approved by the U.S. Food and Drug Administration in 2010 for migraine treatment.

What’s the difference between Botox Cosmetic and Botox for migraines?

– Here are some frequently asked questions about using Botox to help prevent headaches in adults with chronic migraine, Can using Botox for migraine also help with wrinkles? No, using Botox to help prevent headaches due to chronic migraine isn’t likely to help with wrinkles.

A different medication called Botox Cosmetic is used to help with wrinkles. Botox Cosmetic contains the same active drug (onabotulinumtoxinA) as Botox, but it’s given in lower doses. And to treat wrinkles, Botox Cosmetic is given in different injection sites than those used to help prevent headaches. Botox provides relief to only the specific nerves in the muscle groups it’s injected into.

So, receiving Botox injections to help prevent headaches is unlikely to affect wrinkles. If you have questions about using Botox to help prevent headaches or Botox Cosmetic for wrinkles, talk with your doctor.

Where do they inject Botox for migraine?

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)

Who should not use Botox for migraines?

Who is not a good candidate for Botox treatment? – There are some people who should not get Botox for migraine attacks or for any other reason. You aren’t a good candidate for Botox if any of the following apply to you:

known sensitivity or allergy to botulinum toxin (or a history of botulism )signs of infection at or near the injection site neurological conditions that make you more prone to muscle weakness, such as amyotrophic lateral sclerosis (ALS) or myasthenia gravis you’re pregnant or breastfeeding

Is there a difference between Botox and Botox Cosmetic?

Contact us to learn more about Botox and Botox Cosmetic in Charlotte, NC – Carolina Facial Plastics is a team of highly trained professionals in Charlotte, NC, led by myself, Dr. Jonathan Kulbersh, I am a double-board certified facial plastic surgeon specializing in facial plastic surgery.

My team of experts includes two board-certified physician assistants, Heather Bryant, MPAS, PA-C, and Amanda Piligian, PA-C, as well as our board-certified nurse practitioner Courtney Whitley, FNP-C, All three of these expert injectors perform treatments in our state-of-the-art treatment center. It is critical to consult with expert injectors to ensure safe, natural, and successful results.

Our upscale office in the Southpark area offers concierge patient services to ensure a safe and comfortable experience. Contact us to schedule a consultation and learn more about Botox and Botox Cosmetic or book your appointment online, Next, learn how Botox can be used to perform a nonsurgical lip lift,

What is better than Botox for migraines?

For many chronic migraine sufferers, Botox® injections have become a reliable preventive method to reduce the frequency of their migraine headaches, Unfortunately, many doctor offices are closed right now due to COVID-19 complications, making it difficult for people who need Botox® injections to get relief.

Even if you can’t physically see a doctor right now though, telehealth options (like Cove) make it possible to consult with medical professionals about your other options. When working with your doctor to decide what to try next, leading migraine expert and Cove Medical Director Dr. Sara Crystal says, “The CGRP antagonists—Aimovig®, Ajovy®, and Emgality®—would be good options for patients who cannot receive Botox® now due to COVID-19.” Why is this a good place to start? Dr.

Crystal explains that “Botox® works through several mechanisms, some known and some not fully understood. It modulates neurotransmitter release and blocks certain proteins involved in pain transmission. One of these is CGRP, calcitonin gene related peptide, which is very important in the migraine pathway.” She goes on to make an important note though: “Some insurers won’t cover Botox® and the anti-CGRPs at the same time, and this may be a consideration for those who are able to resume Botox® in the near future.” So, what are your other options, in addition to anti-CGRP treatments? We’ve compiled a variety of alternative options that could reduce the frequency of your attacks, even if they’re not quite as effective as Botox® is for you.

While it takes time to find new preventive methods that work for you—an average of three months for many people—all hope isn’t lost.
There are quite a few prescription treatment options available for migraine sufferers who are looking to reduce the frequency of their attacks.
While many people who try Botox® have already tried a few of the below options, we thought it was important to list every option.

Let’s start with the option Dr. Crystal recommends thinking about: anti-CGRP medications, They’re the latest development in migraine treatment and prevention. As mentioned above, CGRP, or calcitonin gene-related peptide, is a pain-related protein that affects the size of blood vessels in your brain.

CGRP levels spike during an attack, so anti-CGRP medications work directly against this spike to regulate CGRP levels.
This reduces the frequency of attacks, shortens their duration, and alleviates pain and other symptoms.
Preventive anti-CGRP medications, currently available via an at-home injection, are FDA-approved to treat episodic and chronic migraine, and are proven effective for migraine with aura or without it.

While not preventive, Dr. Crystal also notes that short-acting anti-CGRPs like Nurtec™ and Ubrelvy®, could be good options for acute treatment. Promising studies show that anti-CGRP medication may work for individuals who have tried other preventive migraine treatments without success—often with fewer side effects than many existing medications.

Though anticonvulsants are commonly prescribed to treat epilepsy, they also help prevent migraine attacks. In fact, a study showed that successful anticonvulsant treatment can reduce frequency by 50%. Similar to anticonvulsants, antidepressants are primarily used to treat a different condition (depression).

But research shows that certain antidepressants can be an effective long-term solution for migraine prevention. The most common category of antidepressants used for migraine prevention are tricyclic antidepressants. They work by helping individuals maintain a healthy serotonin level, which can plummet during an attack.

Typically used to control blood pressure or manage abnormal heart rhythms, beta blockers are also a proven preventive migraine treatment.
They help to relax the blood vessels in your brain, which dilate during a migraine attack.
And by relaxing the blood vessels in your brain, beta blocks allow blood to flow normally again.

There’s no magic pill that’ll cure your migraine, but taking certain supplements—a catch-all term for products like vitamins, minerals, probiotics, and herbal foods—can help provide support for migraine sufferers. Sometimes, a vitamin deficiency could be triggering your migraine attacks or increasing their intensity, so adding a supplement to your daily routine can help.

Of course, that means you have to first identify the deficiency, which may require the help of your doctor.) Below, we’ve outlined some of the most effective supplements you can try.
Experts believe magnesium —a mineral that helps your body regulate muscle and nerve function, among other things—could help prevent cortical spreading depression, or the wave of brain signaling thought to cause migraine attacks.

Magnesium could also block pain-transmitting chemicals in the brain, reducing pain during an attack. Research suggests magnesium can be especially helpful for people who have migraine with aura or menstrual migraine, Strong scientific research suggests that coenzyme Q10, or CoQ10, can help reduce the frequency of migraine headaches.

CoQ10 can help lower CGRP levels that spike during an attack, which can reduce migraine frequency. In fact, one study found that most participants’ headache days decreased by more than 50% after taking CoQ10. It’s difficult to get enough CoQ10 through dietary sources, so taking a supplement is recommended if this is the nutrient you need.

Riboflavin is a natural remedy, and studies have shown that it can help reduce the number of attacks you experience each month. Research on the vitamin’s effect on migraine is limited, but evidence shows that at a high dose (400mg), it’s a safe and well-tolerated migraine prevention alternative.

Riboflavin is present in eggs, green vegetables, lean meats, and dairy products, but to consume enough to prevent migraine attacks, you’ll likely need a supplement.
We know, easier said than done.
And we also know you’ve likely already made several lifestyle changes to keep your migraine attacks as few and far between as possible.

But as you attempt new types of treatment, it’s more important than ever to stay healthy and balanced. So just take these as gentle reminders to practice self-care. Managing stress, especially now, can be incredibly difficult. But since stress can trigger migraine attacks, it’s important to figure out how to relax.

Some of the best ways to relieve everyday tension include exercising regularly and spending time outside as much as you’re able to.
Try yoga, meditation, or relaxation exercises such as deep breathing, or treat yourself to creative hobbies projects that can channel your energy into something more helpful than stress.

You might also want to keep a stress journal to help find patterns and avoid unnecessary triggers. For example, watching the news or spending too much time on social media right now might cause anxiety, and a stress journal can help you identify the need to limit your screen time.

Sleep deprivation is both a migraine trigger and a stress trigger, so it’s important to get enough sleep,
Do your best to establish a pattern of going to bed and waking up at the same time every day.
And for more tips on getting better sleep, see our top sleep tips here,) As you know, doctors aren’t 100% sure what causes migraine, so it’s important to know your migraine triggers (sounds, lights, certain foods, stress, and more).

Does Botox for migraines cause weight gain?

Abstract – Migraine is a chronic headache disorder manifesting in attacks lasting 4-72 hours. Characteristics of headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity, and association with nausea, photophobia and phonophobia.

The migraine aura is a complex of neurological symptoms, which occurs just before or at the onset of migraine headache. Botulinum toxin A represents a completely new option for patients with chronic pain conditions. Numerous retrospective open-label chart reviews and 4 double-blind, placebo-controlled studies have demonstrated that botulinum toxin type A is significantly effective in migraine prophylaxis and reduces the frequency, severity, and disability associated with migraine headaches.

Studies have generally reported a good and consistent efficacy. The differential therapeutic use of botulinum toxin appears to be worth attempting in migraine patients with the following characteristic features: (1) Muscular stress as migraine trigger, e.g., in craniocervical dystonia, pericranial painful muscular trigger points or tender points, oromandibular dysfunction, (2) concurrent chronic tension-type headache with the aggravating factors of muscular stress or oromandibular dysfunction, (3) chronic migraine with frequent migraine attacks on more than 15 days per month for longer than 3 months and if other therapeutic options have been either ineffective or have not been tolerated.

The use of the agent does not cause CNS side effects.
Migraine patients in particular, often suffer greatly, as a result of the adverse effects of the drugs used, from fatigue, dizziness, reduced concentration, loss of appetite, weight gain, hair loss and changes in libido.
These side effects are not known in association with botulinum toxin A.

To date, neither organic damage nor allergic complications have been reported. Thus, both the tolerability and the safety of this therapeutic measure are high. The mode of action by which botulinum toxin is effective in migraine prophylaxis is not fully understood and is under investigation.

What is the success rate of Botox for migraines?

What Is The Success Rate Of Botox For Migraines? – Blog Can Cosmetic Botox Help Migraines Treatment of chronic migraines can be a long arduous process that can become frustrating and painful. For many patients, when initial treatments do not improve the frequency or severity of their headaches, they may come to Allure Esthetic for Botox injections.

For those with chronic migraines, Botox can reduce their frequency and sometimes intensity. Let’s look at the common question, “What is the success rate of Botox for migraines?” Most patients who undergo Botox injections for migraines will see some improvement in their migraines. On average, Botox reduces the frequency of chronic migraines by 50-80%.

For some patients, it may be even more. Migraines may also be less severe. Only a small subset of chronic migraine sufferers see little to no benefit from Botox injections. While the exact results will vary, most find that it is advantageous and improves their quality of life.

How often should you get Botox for migraines?

Botox Injections for Migraines: How It Treats Migraine Headaches Medically Reviewed by Jennifer Robinson, MD on January 25, 2022 If you have been diagnosed with migraine and get migraine headaches often, you may wonder if there’s anything you can do to prevent them. OnabotulinumtoxinA, or Botox, was approved in 2010 for adults who get chronic migraines. That means you have both:

A history of migraine headachesHeadaches (including tension-type) on most days (15 or more) of the month that last 4 hours a day or longer

It is not an approved treatment if you:

Get headaches 14 or fewer days each monthHave other types of headaches, like cluster

Botox is a neurotoxin, a poison made by bacteria called Clostridium botulinums. It can cause a deadly reaction called if you eat it in spoiled food because it blocks signals from your nerves and paralyzes your muscles. But it’s safe because the toxin isn’t digested in your stomach and the dose is much smaller amount than you’d get in spoiled food.

Doctors found that shots of Botox can help smooth wrinkles because it relaxes muscles in the face.
It also helps people who have tics and spasms because of a nerve disease like cerebral palsy.
When people who had migraine headaches used Botox to treat their wrinkles, they told their doctors that their headaches were better.

So doctors began to study it as a migraine pain treatment. In a study of adults who get headaches, shots of Botox cut down the total number of days they had them or even other types of headaches. They also had more “crystal-clear” – pain-free – days each month, and they reported fewer days off work.

In another study, nearly half the people who took two rounds of Botox shots reported that the number of days they had a headache each month was cut in half.
After five rounds of treatment, that increased to about 70% of the people.
Doctors think Botox works for migraine headaches because it blocks chemicals called neurotransmitters that carry pain signals from your brain.

Botox is like a roadblock in that pathway. It stops the chemicals before they get to the nerve endings around your head and neck. You’ll get several shots of Botox around your head and neck once every 12 weeks to dull or prevent migraine headaches. You may need 30 to 40 shots in all, and you’ll get an equal number on each side of your head.

If you have migraine pain in one particular spot, you may need more shots there.
You could see results 2 to 3 weeks after your first treatment.
You should only get this type of Botox treatment from a doctor who’s trained to give these shots for chronic migraine headaches rather than for wrinkles or other cosmetic uses.

Neck pain and headache are the most common side effects for people who get chronic migraine headaches and use Botox. It’s rare, but you can have an allergic reaction to Botox. Signs of this can be hives, shortness of breath, or swelling in your lower legs.

Can Botox in the neck help migraines?

The providers at Hattiesburg Clinic Physical Medicine & Rehabilitation offer BOTOX ® injections for treatment of chronic migraines, neck pain and spasticity. Chronic migraines are throbbing, debilitating headaches that create life interruptions. Often accompanied by nausea or sensitivity to light and sound, migraine headaches make it difficult to enjoy life.

Today, three million Americans suffer from chronic migraines.
Hattiesburg Clinic offers BOTOX ® for migraines, the first and only preventative treatment FDA-approved to reduce headache days in adults with chronic migraines.
BOTOX ® (onabotulinumtoxinA) is a chronic migraine treatment that is injected to prevent headaches in patients 18 or older who have a chronic headache 15 or more days each month with headaches lasting four or more hours.

Many treatment options are used to decrease pain during the onset of a chronic headache. As a preventive treatment, BOTOX ® is used to stop migraines before the onset. In addition to treatment for migraines, BOTOX ® can offer relief to patients who are suffering from chronic neck pain.

Most commonly known for the ability to reduce facial wrinkles, BOTOX ® is a FDA-approved treatment that block the pain signals and minimizes the onset of pain causing the muscles to relax. BOTOX ® is a neurotoxic protein that relaxes the muscles when injected. For optimal results, the BOTOX ® injections are paired with therapy.

Once the patient receives pain relief from the injection, he/she may be recommended to Physical Therapy to rehabilitate the appropriate areas.

What happens if Botox doesn’t work for migraines?

Botox is the most effective and the safest preventive treatment for migraine headaches. However, in a very small number of patients, Botox loses its effectiveness over time. This happens for two main reasons – the person develops antibodies as a defense mechanism to block the effect of Botox or headaches change in character and stop responding to Botox.

It is easy to tell these two reasons apart.
If Botox fails to stop movement of the forehead muscles and the patient can frown and raise her eyebrows, it is most likely because of antibodies.
On a very rare occasion this is due to a defective vial of Botox, so to confirm that antibodies have formed, we give a small test dose amount of Botox into the forehead.

If again there is no paralysis, we know that antibodies have developed. This can happen after one or two treatments or after 10, but in my experience over the past 25 years, significantly fewer than 1% of patients develop this problem. Fortunately, some patients who develop antibodies to Botox, known as type A toxin, may respond to a similar product Myobloc, which is a type B toxin.

Myobloc is not approved by the FDA to treat chronic migraine headaches, but it has a similar mechanism of action and has been shown to relieve migraines in several studies. Injections of Myobloc can be a little more painful, it begins to work a little faster than Botox, but the effect may last for a slightly shorter period of time.

An even smaller number of patients have naturally occurring antibodies to Botox, which is most likely due to an exposure to botulinum toxin in food. I’ve encountered 4 or 5 such patients and a couple of them who did go on to try Myobloc, did not respond to it either.

When Botox stops working despite providing good muscle relaxing effect, it could be because the headaches have changed in character, severity or are being caused by a new problem. It could be due a sudden increase in stress level, lack of sleep, hormonal changes, drop in magnesium level due to a gastro-intestinal problem, or another new illness, such as thyroid disease, diabetes, multiple sclerosis, or increased pressure in the brain.

Such patients need to be re-evaluated with a neurological examination, blood tests, and usually an MRI scan. One of my patients who was doing well on Botox for several years, did not have any relief from her last regular treatment. Since she had no obvious reasons why her migraines should stop responding to Botox, I ordered an MRI scan.

Can Botox worsen migraines?

For some people, botulinum toxin injections (Botox ® ) will help relieve a good portion of their headache symptoms, headache severity, and headache frequency. – For some people, botulinum toxin injections (Botox ® ) will help relieve a good portion of their headache symptoms, headache severity, and headache frequency.

For some people, botulinum toxin injections will make their headache symptoms, headache severity, and headache frequency worse. In this article, I will discuss how botulinum toxin injections may affect you. If you are reading this article you are likely someone who was recently recommended botulinum toxin injections for headaches and you would like to learn a little more, or, you are someone who had botulinum toxin injections and not only did the injections not help you, they made your situation worse and now you are looking for possible answers.

You may also be someone who had botulinum toxin injections with great success and you are wondering why they are now “wearing off,” and your headaches have returned. The people we see in our office are not the people who had great long-term success with botulinum toxin injections.

We see the people for whom the headaches got worse and as the headaches got worse, so did other neurological problems such as vision difficulties, hearing difficulties, dizziness, and more.
Some people contact us after their first series of botulinum toxin injections.
They had a treatment “a few weeks back,” yet they still have terrible muscle spasms, their headaches are just as bad as they have been, and now they have developed new neck pain.

They are here in our office to find out why. Again, let me point out that many people have very successful botulinum toxin injections for their headaches. This article will be about some of the people we have seen, who did not. Injections of botulinum toxin are typically recommended for certain types of headaches.

Does Botox for migraines affect face?

4. You May Look a Bit Different – Many people are drawn to Botox for the perceived cosmetic benefit, but the Botox for migraines injection sites are different from those used for cosmetic purposes. So you can’t count on looking like a movie star if your goal is migraine prevention,

As anyone who’s tried Botox for migraine (or wrinkle reduction) will tell you, your forehead may feel heavier after the injections are done, where the nerve endings are in essence frozen.
In my case, my usually expressive face didn’t track with my emotions: no raised eyebrows of surprise or delight or shock.

So people told me I looked tired, overlooking the grape-sized purple bruise smack dab in the center of my forehead ( see No.5 below). “Yes, I have noticed my eyelids have drooped, I can live with that for now but am looking into surgery for that since it is a ‘medical’ issue,” said Silja P.

Can you use Botox for migraines long term?

A new study has indicated that long-term treatment with onabotulinumtoxin A is effective, safe, and well-tolerated in the patient population. A response rate of 65% is expected after 3 courses of treatment with onabotulinumtoxin A (Botox) in patients with chronic migraine. Now, a new study has indicated that long-term treatment with onabotulinumtoxin A is effective, safe, and well-tolerated in the patient population. Building off of a previous study demonstrating the short-term efficacy of the treatment, which is given every 3 months, the study researchers assessed onabotulinumtoxin A in patients who responded to the treatment after 3 sessions. The open-label, single-arm, prospective, observational study followed patients at 5 headache centers around Greece. “We previously reported that 3 courses of onabotulinumtoxin A prophylactic therapy were able to effectively reduce both the mean headache days/month as well as the days with peak headache intensity >4/10, compared to baseline, in a cohort of 81 patients,” wrote the researchers. “A reduced intake of acute headache medications per month was also apparent.” The 65 patients who had at least a 50% reduction in mean headache days per month after the 3 sessions were followed for 3 years while taking the treatment. The majority (86.1%) remained on the treatment throughout the study period. Among the 9 patients who dropped out, 5 dropped out due to significant improvement and belief that additional sessions were not needed. To determine the sustained efficacy of the treatment, the researchers studied changes from the trimester after the third cycle of onabotulinumtoxin A (10 to 12 months ) to the trimester after completing 2 years of treatment (25 to 27 months ) and to the trimester after completing 3 years of treatment (37 to 39 months ). Between T1 and over 3 years of therapy to T3, there was a significant decrease in mean monthly headache days (7.2 vs 3.4). Similarly, the mean number of monthly days with peak migraine intensity of higher than 4 significantly decreased between T1 and T3 (3.4 vs 2.5). These decreases also led to a significant change in the days of acute headache medication use per month during the time period (4.7 vs 2.8). “Significant changes towards further improvement occurred in all efficacy variables from T2 to T3, thereby supporting the sustained efficacy of onabotulinumtoxin A consistently administered in a long-term basis,” wrote the authors. The researchers highlighted that no patient became resistant to the treatment, and the safety analysis showed that it was safe and well tolerated, without severe side effects. However, they noted that a few patients experienced transient and mild adverse events, including wheals in the injection site and shoulder and/or neck pain. Fifty of the 56 patients that completed the 3 years of treatment continued treatment for additional sessions, and the authors plan to publish the results. Reference: Vikelis M, Argyriou A, Dermitzakis E, et al. sustained onabotulinumtoxin A therapeutic benefits in patients with chronic migraine over 3 years of treatment, J Headache Pain, doi: https://doi.org/10.1186/s10194-018-0918-3.

What is the downside of cosmetic Botox?

Cons of Botox – Botox is generally considered safe. However, there are risks of botulinum toxin injections, like Botox, to be aware of. The side effects and complications include:

Bruising and pain at the injection site Flu-like symptoms Headache Nausea Redness Temporary facial weakness or drooping In rare instances, the botulinum toxin may spread beyond the treatment area, causing botulism-like signs and symptoms such as breathing problems, trouble swallowing, muscle weakness and slurred speech

Additionally, with preventive Botox, you risk “frozen” facial expressions, which results from the procedure’s muscle-relaxing effects. If you don’t have any wrinkles to begin with, you might want to carefully weigh the side effects and outcomes of Botox. Make sure to speak with a licensed medical professional before receiving the treatment to verify this treatment is best for you.

Will Botox help tension headaches?

A chronic tension-type headache is not as debilitating as a migraine but can still reduce one’s quality of life when it recurs and does not respond to medication. Symptoms of a tension headache include steady pain on both sides of your head, intense pressure around your head, and sometimes pain in the lower back of the head.

People who suffer from treatment-resistant tension headaches can now find pain relief with Botox for tension headaches,
Tension headaches are believed to emerge from a combination of factors, such as genetics, stress, and possibly undetected medical issues.
In addition, doctors believe that continuous muscle contractions in the neck and head contribute significantly to the persistence of tension headaches.

Botox not only prevents muscles from contracting but may also help reduce the frequency of tension headaches.

What are the side effects of Botox cosmetics?

Serious adverse effects – The potentially serious events are sequelae due to the systemic spread of toxin leading to botulism-like features or systemic anaphylactic reactions. The cosmetic use of botulinum toxin rarely causes severe side effects. The frequency of serious side effects is 33 times higher for therapeutic than for cosmetic cases.

The median botulinum toxin dose is 4 times higher in reports for therapeutic cases than cosmetic cases, The US Food and Drug Administration (FDA) describes adverse effects as serious if they meet the strict criteria. They are classified as a life-threatening experience requiring intervention to prevent permanent damage and associated with patient hospitalization or prolongation of existing hospitalization, and persistent or significant disability,

In 2005, the FDA reported 36 adverse effects related to cosmetic use, which met the FDA’s definition of serious adverse events, with the majority concerning dysphagia, Serious adverse effects after cosmetic use of botulinum toxin include dysphagia, muscle weakness, and allergic reactions,

Dysphagia and muscle weakness are common symptoms of botulism.
Cosmetic treatment of cervical wrinkles and lines usually requires larger doses of botulinum toxin and increases the risk of serious side effects.
Platysmal injections in large doses (50 units and higher) to correct prominent vertical bands and horizontal neck lines may cause weakness of the neck flexors and temporary dysphagia, and, in rare cases, hoarseness.

Older patients and larger doses increase the possibility of direct botulinum toxin injections or localized diffusion into the deeper cervical structures. Botulinum toxin can spread to a distance of 30–45 mm from the injected muscles to the adjacent muscles, even if these muscles are separated by fasciae.

Neck muscles are prone to diffusion of botulinum toxin, and paralysis of the wrong muscles leads to dysphonia, dysphagia or dystonia.
Mild and transient cervical discomfort usually occurs 2 to 5 days after injection.
Dysphagia occurs on average 9.7 days after the injection and lasts on average 3.5 weeks.

Clinically significant dysphagia resolves spontaneously within 2 weeks. If severe dysphagia is noted, a temporary change to a soft diet may be instituted and emotional support provided until full recovery occurs. Patients with severe dysphagia require nasal feeding or intravenous nutrition to maintain the water-electrolyte balance.

One of the most common serious adverse effects of botulinum toxin is muscle weakness. This may involve injected muscles as well as adjacent muscles, or it may manifest as generalized muscle weakness. This weakness recurred a year after the first injection, This wide spectrum of symptoms associated with muscle weakness or paralysis, dysarthria, dysphonia, dysphagia and respiratory arrest is known as botulism.

The first symptoms of botulism may be severe and long-lasting headache and fatigue. Some researchers report that up to 1% of patients who receive botulinum toxin injections may experience severe, debilitating headaches, According to Bai et al., botulism can be classified into mild botulism with developing dizziness, headache, fatigue, blepharoptosis, and/or blurred vision, not affecting normal life; moderate botulism that additionally manifests dysphagia and/or bucking, and nasal feeding is adopted accordingly; and severe botulism, when apart from all of the aforementioned symptoms, respiratory failure appears and mechanical ventilation is applied,

Botulism is dose-dependent and results from the diffusion of the botulinum toxin into adjacent muscles from the injected muscles. It is interesting that botulism can occur even a few years after continued injections. Usually, toxic effects of botulinum toxin can appear at the 10 th or 11 th injection, after prior uncomplicated injections.

The clinical symptoms of botulism after cosmetic use occur 0 to 36 days after injection, mainly between the 2 nd and 6 th day following the operation, Differential diagnosis is conducted to discriminate botulism from myasthenia gravis, Guillain-Barré syndrome, cerebrovascular diseases, cervical vertebra diseases, and polymyositis.

Treatment is based on the administration of neurotrophic drugs, systemic support and symptomatic treatment, and the injection of botulinum antitoxin serum.
In cases of moderate to severe botulism, vital signs should be monitored closely.
Severe-case patients should accept tracheal intubation and mechanical ventilation.

Patients with a negative skin test should receive 10 000 IU of antitoxin serum via intramuscular injection once every 12 h; patients with a positive or weak positive skin test should receive 10 000 IU via desensitization injection once a day, Early application of botulinum antitoxin serum and certain symptomatic support treatments, such as active infection prevention, is important for botulism treatment.

The earlier the treatments are performed, the better the effects are,
The mechanism responsible for the generalized diffusion of botulinum toxin is not known.
Hypotheses proposed concern either systemic spread or retrograde axonal spread of toxin.
It is not clear whether the generalized diffusion is due to the spread of botulinum toxin or of its inactive metabolites,

The toxin may be able to traverse through an intact vessel wall. In addition, accidental intravenous delivery of the toxin may occur when it is injected into muscle, Diffusion of botulinum toxin to contralateral muscles has also been reported. Moreover, experimental studies have shown that botulinum toxin receptors exist in the central nervous system and a small amount of botulinum toxin crosses the blood-brain barrier.

This raises the possibility that botulinum toxin is transported retrogradely, similarly to tetanus toxin, and may cause centrally mediated side effects. Another theory postulated relates to absorption of a small amount of botulinum toxin into the bloodstream and its systemic action, In addition to the mechanism of generalized diffusion, another source of severe side effects is anaphylactic shock.

It is attributed to the chemical structure of the drug, resulting in hypersensitivity reactions. Using standard emergency protocols and medications such as epinephrine and methylprednisolone is advised when indicated, rather than diphenhydramine, because of its anticholinergic effects.

There is no difference in the frequency of anaphylactic shock between the cosmetic and therapeutic use of botulinum toxin,
Repeated injections cause immune complexes to form in the botulinum toxin, which induces blocking of antibodies.
Other immune-mediated reactions are the source of both hypersensitivity and immunoresistance to botulinum toxin.

Some reports indicate that antibotulinum toxin A antibodies can occur in 5% to 10% of patients who receive repeated, long-term, high-dose botulinum toxin treatments. Other types of BoNT-A have different antigenicity. It was reported that incobotulinumtoxinA (Xeomin) is characterized by reduced antigenicity,

Antibody development against various components of botulinum toxin complex is evidence of systemic botulinum toxin exposure.
The factors that contribute to antibody formation include longer duration of treatment, a shorter time interval between injections, larger overall doses, and decreased purity of botulinum toxin preparation,

Formation of antibodies is estimated at less than 1%, Immunoresistance is another entity that has been clinically described in selected patients, especially those injected with large doses in multiple treatment sessions, Clinically significant botulinum toxin resistance is less common in patients who receive the lower doses of botulinum toxin that are typically administered in cosmetic treatments.

On the other hand, immunoresistance in the cosmetic use of botulinum toxin results in a higher risk of dose-dependent serious side effects.
Immunoresistance develops within the first years of therapy.
If immunoresistance to botulinum toxin is not noted within the first 4 years, then it is unlikely to develop.

Those who develop immunoresistance can be treated with breakthrough doses of botulinum toxin, or with nontype A botulinum toxin, such as botulinum toxin B, The lack of sensitivity to botulinum toxin can be attributed to a number of reasons, from inappropriate diagnosis to inappropriate target muscle selection or injection, or from the use of an amount of botulinum toxin insufficient to elicit the desired pharmacological outcome to the presence of antitoxin-neutralizing antibodies.

Some research has excluded the possible role of mutations affecting either binding or substrate cleavage of botulinum toxin in the mechanisms of primary resistance to botulinum toxin,
Repeated injections may eventually enhance the pathological innervation, leading to tolerance and even exacerbation of local symptoms.

Moreover, they cause muscle fibrosis after several years, though such an effect has not been shown in shorter follow-up so far. Furthermore, medications that inhibit neuromuscular signaling, such as aminoglycosides, quinidine, anticholinergics and muscle relaxants, may potentiate botulinum toxin effects,

Serious adverse events related to the cosmetic use of botulinum toxin include thyroid eye disease in a patient with Graves hyperthyroidism, sarcoidal granuloma, pseudoaneurysm of the frontal branch of the superior temporal artery, and severe respiratory failure. It seems that cosmetic use of botulinum toxin is not time-dependant.

There is no evidence of cumulative adverse events after cosmetic use of botulinum toxin. Moreover, the event rate decreases in later treatment cycles. Furthermore, there are no severe adverse effects in patients who regularly repeat botulinum toxin injections for cosmetic indications ( Table 1 ).

Is there a permanent cure for migraines?

There’s currently no cure for migraines, although a number of treatments are available to help ease the symptoms. It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones. If you find you cannot manage your migraines using over-the-counter medicines, your GP may prescribe something stronger.

What is the best treatment for chronic migraines?

Treatment – Treatment for an underlying condition often stops frequent headaches. If no such condition is found, treatment focuses on preventing pain. Prevention strategies vary, depending on the type of headache you have and whether medication overuse is contributing to your headaches.

Antidepressants. Tricyclic antidepressants — such as nortriptyline (Pamelor) — can be used to treat chronic headaches. These medications can also help treat the depression, anxiety and sleep disturbances that often accompany chronic daily headaches. Other antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac, Sarafem, others), might help in treating depression and anxiety, but have not been shown to be more effective than placebo for headaches. Beta blockers. These drugs, commonly used to treat high blood pressure, are also a mainstay for preventing episodic migraines. These include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) and propranolol (Inderal, Innopran XL). Anti-seizure medications. Some anti-seizure drugs seem to prevent migraines and might be used to prevent chronic daily headaches, as well. Options include topiramate (Topamax, Qudexy XR, others), divalproex sodium (Depakote) and gabapentin (Neurontin, Gralise). NSAIDs. Prescription nonsteroidal anti-inflammatory drugs — such as naproxen sodium (Anaprox, Naprelan) — might be helpful, especially if you’re withdrawing from other pain relievers. They can also be used periodically when the headache is more severe. Botulinum toxin. OnabotulinumtoxinA (Botox) injections provide relief for some people and might be a viable option for people who don’t tolerate daily medication well. Botox would most likely be considered if the headaches have features of chronic migraines.

The use of one drug is preferred, but if one drug doesn’t work well enough, your doctor might consider combining drugs.

What is the new migraine medication for 2023?

Pfizer’s ZAVZPRET™ (zavegepant) Migraine Nasal Spray Receives FDA Approval – Friday, March 10, 2023 – 06:45am ZAVZPRET is the first and only calcitonin gene-related peptide (CGRP) receptor antagonist nasal spray for the acute treatment of migraine in adults Expands Pfizer’s migraine portfolio, which includes an oral therapy for both acute and preventive treatment, to further meet the needs of people living with this debilitating disease NEW YORK-(BUSINESS WIRE)- Pfizer Inc.

(NYSE: PFE) today announced the U.S. Food and Drug Administration (FDA) has approved ZAVZPRET™ (zavegepant), the first and only calcitonin gene-related peptide (CGRP) receptor antagonist nasal spray for the acute treatment of migraine with or without aura in adults. In its pivotal Phase 3 study, ZAVZPRET was statistically superior to placebo on the co-primary endpoints of pain freedom and freedom from most bothersome symptom at two hours post-dose.

The pivotal study also demonstrated pain relief as early as 15 minutes in a prespecified secondary endpoint versus placebo. “The FDA approval of ZAVZPRET marks a significant breakthrough for people with migraine who need freedom from pain and prefer alternative options to oral medications,” said Angela Hwang, Chief Commercial Officer, President, Global Biopharmaceuticals Business, Pfizer.

ZAVZPRET underscores Pfizer’s commitment to delivering an additional treatment option to help people with migraine gain relief and get back to their daily lives.
Pfizer will continue to build its migraine franchise to further support the billions of people worldwide impacted by this debilitating disease.” The FDA approval is based on two pivotal randomized, double-blind, placebo-controlled studies that established the efficacy, tolerability and safety profiles of ZAVZPRET for the acute treatment of migraine.

In these studies, ZAVZPRET was statistically superior to placebo on the co-primary endpoints of pain freedom (defined as a reduction of moderate or severe headache pain to no headache pain) and freedom from most bothersome symptom at two hours post-dose (defined as the absence of the self-identified most bothersome symptom).

The pivotal Phase 3 study published in The Lancet Neurology found ZAVZPRET showed broad efficacy by also demonstrating statistically significant superiority to placebo across 13 of 17 prespecified secondary outcome measures, including early time point endpoints (e.g., 15 and 30-minute pain relief and return to normal function at 30 minutes), return to normal function at 2 hours, and durable efficacy endpoints (e.g., 2-24 and 2-48 hour sustained pain freedom and sustained pain relief).

On the 14th endpoint, return to normal function at 15 minutes post-dose, the difference between ZAVZPRET and placebo was not significant. Consequently, in keeping with the trial’s statistical analysis plan, the remaining secondary endpoints were not formally tested.

When a migraine hits, it has a significant negative impact on a person’s daily life,” said Kathleen Mullin, M.D., Associate Medical Director at New England Institute for Neurology & Headache. “Among my migraine patients, one of the most important attributes of an acute treatment option is how quickly it works.

As a nasal spray with rapid drug absorption, ZAVZPRET offers an alternative treatment option for people who need pain relief or cannot take oral medications due to nausea or vomiting, so they can get back to normal function quickly.” ZAVZPRET was well tolerated in clinical trials.

The most common adverse reactions reported in at least 2% of patients treated with ZAVZPRET and at a frequency greater than placebo were taste disorders (includes dysgeusia and ageusia), nausea, nasal discomfort and vomiting. ZAVZPRET is contraindicated in patients with a history of hypersensitivity to zavegepant or to any of its components.

Hypersensitivity reactions, including facial swelling and urticaria, have occurred with ZAVZPRET in clinical studies. ZAVZPRET is anticipated to be available in pharmacies in July 2023. About Migraine Nearly 40 million people in the United States suffer from migraine 1 and the World Health Organization classifies migraine as the second leading cause of disability in the world.2 Migraine is characterized by debilitating attacks lasting four to 72 hours with multiple symptoms, including pulsating headaches of moderate to severe pain intensity often associated with nausea or vomiting, and/or sensitivity to sound (phonophobia) and sensitivity to light (photophobia).3 About CGRP Receptor Antagonism Small molecule CGRP receptor antagonists represent a novel class of drugs for the treatment of migraine.

For acute treatment, this unique mode of action offers an alternative to other agents, including those patients who have contraindications to the use of triptans or who have a poor response to triptans or are intolerant to them. CGRP signal-blocking therapies have not been associated with medication overuse headache (MOH) or rebound headache, which can limit the clinical utility of other acute treatments.

About ZAVZPRET Zavegepant is a third generation, high affinity, selective and structurally unique, small molecule CGRP receptor antagonist and the only CGRP receptor antagonist in clinical development with both intranasal and oral formulations. INDICATION ZAVZPRET™ (zavegepant) is indicated for the acute treatment of migraine with or without aura in adults.

Limitations of Use: ZAVZPRET is not indicated for the preventive treatment of migraine. IMPORTANT SAFETY INFORMATION Contraindications: Hypersensitivity to ZAVZPRET or any of its components. Warnings and Precautions: Hypersensitivity reactions, including facial swelling and urticaria, have occurred with ZAVZPRET.

If a hypersensitivity reaction occurs, discontinue ZAVZPRET and initiate appropriate therapy. Adverse Reactions: Most common adverse reactions (occurring in ≥2% of patients treated with ZAVZPRET and greater than placebo) for ZAVZPRET vs placebo were taste disorders including dysgeusia and ageusia (18% vs 4%), nausea (4% vs 1%), nasal discomfort (3% vs 1%), and vomiting (2% vs 1%).

Drug Interactions: Avoid use with drugs that inhibit or induce OATP1B3 or NTCP transporters.
Avoid use of intranasal decongestants; if unavoidable, administer intranasal decongestants at least 1 hour after ZAVZPRET administration.
Use in Specific Populations: Hepatic Impairment : Avoid use in patients with severe hepatic impairment.

Renal impairment : Avoid use of ZAVZPRET in patients with creatine clearance (CLcr) less than 30 mL/min. Please click here for full Prescribing Information, About Pfizer: Breakthroughs That Change Patients’ Lives At Pfizer, we apply science and our global resources to bring therapies to people that extend and significantly improve their lives.

We strive to set the standard for quality, safety and value in the discovery, development and manufacture of health care products, including innovative medicines and vaccines.
Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time.

Consistent with our responsibility as one of the world’s premier innovative biopharmaceutical companies, we collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world.

For more than 170 years, we have worked to make a difference for all who rely on us. We routinely post information that may be important to investors on our website at www.pfizer.com, In addition, to learn more, please visit us on and follow us on Twitter at @Pfizer and @Pfizer News, LinkedIn, YouTube and like us on Facebook at Facebook.com/Pfizer,

Pfizer Disclosure Notice The information contained in this release is as of March 10, 2023. Pfizer assumes no obligation to update forward-looking statements contained in this release as the result of new information or future events or developments. This release contains forward-looking information about ZAVZPRET™ (zavegepant), including an approval in the U.S.

for the acute treatment of migraine with or without aura in adults, the timing of anticipated availability and its potential benefits, that involves substantial risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. Risks and uncertainties include, among other things, uncertainties regarding the commercial success of ZAVZPRET; the uncertainties inherent in research and development, including the ability to meet anticipated clinical endpoints, commencement and/or completion dates for clinical trials, regulatory submission dates, regulatory approval dates and/or launch dates, as well as the possibility of unfavorable new clinical data and further analyses of existing clinical data; the risk that clinical trial data are subject to differing interpretations and assessments by regulatory authorities; whether regulatory authorities will be satisfied with the design of and results from the clinical studies; whether and when applications may be filed in particular jurisdictionsfor ZAVZPRET for the acute treatment of migraine with or without aura in adults or any other potential indications; whether and when regulatory authorities may approve any such applications for ZAVZPRET that may be pending or filed, which will depend on a myriad of factors, including making a determination as to whether the product’s benefits outweigh its known risks and determination of the product’s efficacy and, if approved, whether ZAVZPRET will be commercially successful; decisions by regulatory authorities impacting labeling, manufacturing processes, safety and/or other matters that could affect the availability or commercial potential of ZAVZPRET; uncertainties regarding the impact of COVID-19 on Pfizer’s business, operations and financial results; and competitive developments.

A further description of risks and uncertainties can be found in Pfizer’s Annual Report on Form 10-K for the fiscal year ended December 31, 2022 and in its subsequent reports on Form 10-Q, including in the sections thereof captioned “Risk Factors” and “Forward-Looking Information and Factors That May Affect Future Results”, as well as in its subsequent reports on Form 8-K, all of which are filed with the U.S.

Buse et al. Burden of Illness Among People with Migraine and ≥ 4 Monthly Headache Days While Using Acute and/or Preventive Prescription Medications for Migraine. Journal of Managed Care & Specialty Pharmacy,2020;26(10):1334-1343.GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018;17(11):954-976.Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia,2018;38(1):1–211.

View source version on businesswire.com : https://www.businesswire.com/news/home/20230309005795/en/ Media Contact: +1 (212) 733-1226 Investor Contact: +1 (212) 733-4848 Source: Pfizer Inc.

Do you get Botox in your forehead for migraines?

Can Cosmetic Botox Help Migraines DEAR MAYO CLINIC: I have suffered with migraines on and off for about five years. Recently, the oral therapy I’ve used seems to be less effective. While I know newer medications are available, a friend suggested I try Botox injections. She swears it brought her chronic headaches under control.

How safe are these injections, and how does Botox work? What is the treatment schedule, and would I also need to be on other headache medication, too? ANSWER: Onabotulinum toxin A, or Botox, was approved by the Food and Drug Administration in 2010 to treat chronic migraine headaches,
It is not a cure.

Botox is a medication that uses a form of botulinum toxin to temporarily paralyze muscle activity. Best known for its ability to reduce the appearance of facial wrinkles, Botox also has been shown to prevent chronic migraine headaches in some people. It is used mainly for those who have headaches 15 or more days per month.

The treatments are not given more often due to a small possibility that if you receive Botox more frequently, your body might build up antibodies to botulinum toxin.
Those antibodies could in theory prevent Botox from working with future injections.
For many people, treatment with Botox alone is sufficient to control their chronic headaches. However, some people require more care, including additional medications to prevent migraine attacks.

Uncommonly, the medication may spread into nearby tissues and cause problems, such as a drooping eyelid, eyebrows that look out of place, dry eyes or excessive eye tearing. This tends to happen more in people who already have some eye drooping or are more sensitive to botulinum toxin. Sometimes, changing the injections to a slightly different location can reduce this side effect.

Botox injections are expensive. They can cost several thousand dollars per set of injections. Many insurance companies will cover the injections if a patient meets criteria for chronic migraine headache. For at least three months, a person must have a headache occurring on 15 or more days per month that has the features of a migraine on at least eight days per month.

How long does migraine Botox take to inject?

What is the Procedure Like? – Expect a Botox for migraines treatment to take less than 30 minutes. Multiple injections will be given in key areas of the head and neck. There are a total of 31 potential injection sites, but the diagnosis will determine the number needed.

How many needles is Botox migraines?

Bottom Line –

The recommended total dose of Botox (onabotulinumtoxinA) for chronic migraine prevention is 155 Units administered intramuscularly (into the muscle). This is given as 0.1 mL (5 Units) injections divided across 7 specific head and neck muscle areas, for a total of 31 individual injections per session. The injections feel like a small pinprick. Injections take about 15 minutes and you can usually go back home, to work, or on to your normal routine afterwards.

This is not all the information you need to know about Botox for safe and effective use for migraine. Review the, and discuss this information and any questions you have with your doctor. : How many units of Botox are used for migraines?