Many migraine sufferers are finding relief with Botox injections in specific areas in the head, neck, and shoulders. Photo by Sam Moqadam on Unsplash.
First, a story…
I suffer from migraines. I had my first attack when I was eleven or twelve, but I remember it like it was yesterday. Imagine it: a gangled, pale, faintly mustachioed preteen girl sprinting headlong through the first lap of puberty— awkward, uncoordinated, and silly, but nevertheless thrilled to be alive and leaving childhood behind. The day the attack happened, I had just returned from hours spent swimming in a nearby lake with my best friends. During the day’s excursion, the old boat belonging to my friend’s parents stalled and gave out in the middle of the water, leaving us stranded at least a mile from any tenable shore. So, we each grabbed a rope and paddled the boat to the dock with our combined adolescent strength (which wasn’t much). It took forever, and by the time we safely arrived at my friend’s house, I was exhausted. Little did I know that the combined forces of my hormonal maelstrom, more-than-normal physical exertion, and probably a bit of hunger and dehydration were all that it took to cross a few wires. Within a few minutes of sitting down to rest, I couldn’t see. Large patches of my vision had simply phased out, like someone had dribbled purple ink in my eyes and I couldn’t blink it away. Visual stains. My fingers and face were numb. My balance was off. Worse still, when I tried to tell my friends what was going on, my speech slurred. My sentences confused themselves. My lips blubbered and sagged. By some miracle, I was able to say enough to prompt someone to call my mom and she came to my rescue. The pain began on the drive home. The next few hours passed in a blur. Tylenol wasn’t enough to dull the ache hollowing out my eyes. I remember the pain became so severe at one point that I stumbled to the bathroom in the dark to vomit. A week later, my pediatrician said I’d had a severe migraine. “A mini-stroke, heh,” he chortled, as if saying the word ‘stroke’ wasn’t the wretched horror that it was.
Over a decade, almost no answers, many more attacks later, every migraine is still a knockout punch. Careful efforts to avoid unwieldy hormonal imbalances, overexertion, and abnormal hunger or thirst are usually enough to keep them at bay, but sometimes they just happen. For those ‘just happenings,’ no medication that I’ve tried has worked for me consistently. Excedrin Migraine. Nurtrec pills. Triptan nasal sprays. Nada.
Now, I haven’t given up my hunt for the perfect emergency medicine, but my condition has prompted many a late-night googling, one of which unearthed this fascinating finding: Botox can treat migraines.
That’s right! Stiff-browed, plump-lipped, Martha-Mae-Who-ed, tiny-dogs-in-tiny-bags Botox!
The Data
Detailed in an article published by Dr. Fayyaz Ahmed and Dr. Rubesh Gooriah of the UK’s Hull Royal Infirmary, the discovery of using Botox for migraine relief was “incidental,” and happened “while treating patients cosmetically for wrinkles.” While the biological mechanisms behind the surprising treatment are still not entirely understood, the results of the happy accident speak for themselves! In Ahmed and Gooriah’s research, “51% [of subjects with clinically definite migraines] reported a complete remission lasting an average of 4.1 months, and 38% responded partially for a mean duration of 2.7 months.” So, after injections, over half of their test subjects with severe migraines were off the hook for a few months! For people who suffer from attacks, this data is nothing short of miraculous!
The actual treatment consists of 31 small injections administered to different muscles in the head, neck, and shoulders and takes no longer than half an hour. Botox itself is a neurotoxic substance produced by bacteria that attacks the body’s nerves (this bacteria is responsible for the nasty ailment we know as botulism). This bacterial substance then works to paralyze the receptors associated with pain transmission and prevents the muscular contractions that incite migraine attacks. Despite this alarming fact, Botox is safe to use, has been approved by the FDA, is readily prescribed by neurologists and other migraine specialists, and is at least partially covered by most insurance plans, including Medicare and Medicaid. Patients are monitored and injections are repeated every few months for the best results.
All that being said, Botox has been used to treat chronic migraines, not episodic migraines. Clinically, because most of my days are migraine-free, I classify as having episodic migraines, not chronic. However, seeing that chronic migraine is the needy girlfriend of episodic migraine, anything that works for one should work for both, right? Will I spend thousands of dollars on routine Botox injections to prevent an attack I only get once or twice a year? Probably not. But it gives me hope knowing that there are effective migraine treatment options out there aside from the typical pill or spray. And where there is one, there are potentially many!
As scientists discover more and more about the use of Botox and similar substances to treat migraine, I have hope that attacks will become less common both in the world and in me. Modern medicine is advancing with impressive speed and COVID-19 has only worked to expedite that breakneck pace.
In the meantime, I’ve made an appointment with a new neurologist and a new spell of optimism.
My Tips for Preventing Migraines
If you suffer from migraines like me and are looking for new ways to prevent them, I’ve prepared some tips that I’ve used to ward them away when possible. Be aware that these are lifestyle suggestions, not hard-and-fast medical truisms. I’m not a doctor, I’m a patient. Additionally, many migraine sufferers have no power over the onset of an attack. However, if we’re in the same boat, these may prove helpful.
- Track your hormones. This is possible with free apps for download, take-home saliva tests, in-office blood tests, and old-fashioned proprioception. Becoming aware of my hormonal cycle helped me correlate certain crests and troughs with the frequency of attacks. Thus far, I’ve determined that I’m most prone to an attack when my estrogen levels are on the decline, or my luteal phase. Because I know this, I prepare ahead of time and make sure to avoid attack triggers on those days. My attack triggers are hard exercise, sleep debt, dehydration, and hunger, so I take it easy, keep water close by, and bring snacks to work. Your triggers could be completely different, but tailoring your lifestyle to work in harmony with your hormones could be incredibly helpful in the long run. Also be aware that hormonal tracking is available for men, women, and nonbinary individuals! Not just women!
- Be committed to a sleep schedule. I cannot stress the importance of this enough. Not only is getting enough sleep vital in the fight against migraines, but sleeping at the same time every day works wonders for normalizing your bodily processes and making your migraines more predictable. And if it’s predictable, it’s preventable! Sometimes sleep will be disrupted. Sometimes you have an assignment to finish. Sometimes you work two or three jobs. Sometimes you have a newborn baby to take care of. Sometimes life just has other plans! However, when you can help it, hit the hay and hit it consistently. No fun late night out is worth the agony.
- Experiment with a health log. This can be an easy one to become too stringent about (been there, done that), but if you are struggling to identify the patterns in your life that are pro-migraine, keeping a loose shorthand log of the things you do each day can be very beneficial. Jot down the times you wake up and lay down to go to sleep. Note what and when you eat. Log your water intake, your medicines, your bowel movements, your exercise. If you start feeling strange, write down what you feel and how long you feel that way. Eventually, you’ll start picking up on patterns.
- Exercise regularly. Gosh, this is an annoying tip. I am not a regular exerciser by any means (again, overexertion is a quick trigger of mine), but I’ve noticed that when I work to embed exercise throughout my day, I feel less stressed. A body without exercise becomes saturated with cortisol, our main stress hormone. Having excess cortisol is directly linked to migraines, chronic headaches, depression, anxiety, memory and concentration issues, weight gain, and a laundry list of other unpleasant side effects. To combat this, finding frequent, easy ways to work down that cortisol level through movement is key. Go for walks, take the stairs two at a time, try yoga or stretching, do squats while you wait for your microwave dinner to finish. Whatever you can do, do!
- Correct your posture. Believe it or not, how you sit and stand can cause migraines. Studies show that those who suffer from migraine attacks are more likely to have “forward head posture,” or a slouch. Properly aligning your spine can impact the function of your nervous system immensely, and wear and injury to your spinal cord “increase the odds of a migraine diagnosis more than fourfold.” So listen to your mother and sit upright for goodness sake! I feel better all-around when I use proper posture. If you lack motivation on this one, keep in mind that it’s not about etiquette or aesthetics, it has a practical function and will help everything in your body do its job.
- Avoid carrying heavy bags AND carrying them on one shoulder. This one sounds silly, but uneven weight distribution on your shoulders and neck can do huge amounts of damage to your nervous and circulatory systems (in fact, a friend of mine triggered a full-blown stroke from wearing a backpack strap too close to his neck while he ran). So, keep your nerves and veins pressure and pinch-free by investing in a comfortable backpack for everyday use instead of a satchel, purse, or messenger bag. Additionally, your bag should never weigh more than 10% of your body weight, otherwise, you risk adding pressure to muscles where some migraines originate. Throughout college, I noticed a marked difference in my mood when I started carrying my backpack on both shoulders rather than just doing my casual one-strap. Plus my shoulders hurt a lot less. I don’t know if making the switch prevented any migraines, but it definitely didn’t hurt.
- Be open to sharing your experiences. Dealing with migraines is hard enough on its own, so don’t tackle it by yourself. Make a point to talk about it with your loved ones, friends, family members, co-workers, mentors, and therapists. It’s good to advocate for yourself and expand your network of support. Will doing so prevent attacks? No, not necessarily. However, when a migraine strikes, your recovery will be easier knowing that you prepared your ‘fallout squad’ with the information they need to take care of you and the things you care about. So, talk! Make a plan, recruit a small team of people you trust, then connect them to each other so they can coordinate your care. My migraines send everything to a crashing halt for a few days— work, school, church, cooking, cleaning, socializing, etc.— and so I rely on my people to help my fall feel more like a stumble. In addition, migraines are debilitating potentially traumatic. Suddenly losing sight or speech or feeling intense pain without warning even once is reason enough to seek help from a mental health professional and ensure that the attack(s) has no lasting effect on your psyche. You may be surprised what you find out!
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