Dr. Megan Donnelly
Dr. Megan Donnelly

Migraines are debilitating. If you have a headache, you might take an over-the counter pain killer and go about your day. But migraines can demand that you stop cold. Dr. Megan Donnelly of Novant Health Neurology & Headache - SouthPark is a board-certified headache specialist and neurologist and Novant Health’s director of headache and women’s neurology.

June is National Migraine and Headache Awareness Month, the ideal time to learn about one of the most effective treatments for migraine from an expert.

What constitutes a migraine? How is it different from a bad headache?

Migraine is a moderate to severe headache lasting at least four hours. Patients describe it as “throbbing” and “pounding,” and those sensations usually happen on just one side. It is often accompanied by sensitivity to light and sound and/or nausea. About 20% of patients get aura, which is a sensory warning about 15 minutes before the migraine. Aura can include zig-zags across the vision, numbness in one hand or difficulty finding the right word.

Migraine is disabling and greatly affects someone’s life. It is the second-leading cause of disability worldwide. So, getting control of migraine disease is important for someone’s quality of life, well-being and productivity at home and at work.

Is the migraine experience different for women?

Yes. Due to hormonal changes, women experience migraine more frequently, and for a lot of women with migraine, menses itself can trigger migraine. We also have changes in headache/migraine frequency in pregnancy and postpartum, as well as related to perimenopause.

How does Botox work as a migraine preventative?

Botox is FDA-approved for chronic migraine (which is more than 15 headache days per month, for at least several months), if someone has tried, but not had benefit from, other oral medications first.

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Does this vary from patient to patient?

Since this is a set, FDA-approved protocol, there is not much variability in where the injections are placed. But it can be tweaked a little for individual patients based on their needs and response to Botox.

What kind of patient typically does well with Botox for migraine?

Patients with intractable chronic migraine, who have either had side effects from oral daily preventative migraine medication or haven’t found it effective.

Are there certain kinds of migraine that don't respond well to Botox?

No. It can be used in any type of migraine, as long as migraines are occurring 15 days per month or more. It is not approved for other headache disorders, though, such as tension headache or cluster headache.

Does insurance cover it?

Your doctor will apply to your insurance to get it preapproved before you receive it. This application process usually takes at least a month, unfortunately.

Do many plans cover it?

Yes, a lot of standard insurance plans cover this medical procedure.

What kinds of costs can patients expect?

It varies widely from one insurance plan to another, but the cost of each round for the patient is normally between $50 and $500. But the makers of Botox for migraine do have a patient assistance program that can help, as well.

What ongoing maintenance is involved in getting Botox for migraine?

You would see your doctor every three months for the series of injections. We often like to see you some time after you’ve received your set of injections to see how you are doing, if you are having any side effects, and how well it’s working.

How often will you receive shots?

You get 31 shots across the forehead, temples, back of the head and shoulders in a visit that takes about 15 minutes, and then get another round every three months.

Can you get Botox for migraine if you're also doing it with an esthetician to reduce wrinkles?

Great question! It is usually recommended to get Botox from only one place, once every three months. There is a theoretic risk of developing antibodies to Botox if it’s given more frequently. And there is also a risk of weakness if you are receiving a lot of Botox from different providers.

What are some of the potential risks or side effects of the shots? Anyone it's unsafe for?

If it’s done incorrectly, or if too much Botox is used, or if someone is overly sensitive to Botox, it can cause weakness in the eyelids, neck or shoulders. And as with any injection, there is risk of bruising, bleeding and infection, but those risks are deemed quite low. It is not approved for patients under the age of 18.