By Dr. Micah Burns, Interventional Pain Specialist
Chronic headaches, such as chronic migraines and post-traumatic headaches, can be debilitating. In recent years, Botox has emerged as a promising treatment for these conditions. This blog explores the effectiveness and considerations of using Botox for chronic headache relief. 
Understanding Chronic Headaches Â
- Chronic Migraines: Characterized by headaches that occur on 15 or more days per month for more than three months, with migraine features on at least eight days per month.
- Post-Traumatic Headaches: These headaches develop after a head injury and can mimic migraines or tension-type headaches. Â
Symptoms may include intense, severe, throbbing pain, sensitivity to light and sound, and in some cases, aura. Â
Botox: An Overview Â
Botox, or Botulinum toxin, is a neurotoxin known for its ability to relax muscles and stop the transmission of nerve signals. It’s been used for various medical and cosmetic purposes. For headache treatment, Botox works by blocking neurotransmitters that carry pain signals from the nerves that provide sensation to the face, neck and shoulders, helping to reduce headache frequency and severity. Â
Botox Treatment for Headaches Â
The procedure involves: Â
- Multiple Injections: Botox is injected into specific areas around the head and neck. The standard is called the PREEMPT protocol and involves 31 injections of 5U each. 
- Frequency: Typically administered every 12 weeks, can be as often as 10 weeks when medically necessary.
- Gradual Effect: Patients may notice improvement within 2 weeks after initial treatment. Some patients need up to 3 treatments to get full effect.  
Effectiveness Â
- Chronic Migraines: Studies show significant reduction in headache days for chronic migraine sufferers. Â
- Post-Traumatic Headaches: Evidence suggests potential benefits, though more research is needed.
Possible Side Effects
While Botox is generally safe, potential side effects include: Â
- Muscle weakness near the injection sites. Â
- Eyelid drooping or swelling. Â
- Allergic reactions (rare). Â
There is an option to receive Botox treatment for chronic headaches, with consideration taken for aesthetic results. The standard PREEMPT protocol does not provide injections into the facial muscles and so any aesthetic result (good or bad!) is purposefully avoided.  Â
Conclusion Â
Botox offers a valuable treatment option for those struggling with chronic migraines and other types of headaches. If standard treatments haven’t worked for you, discuss the possibility of Botox therapy with your pain physician. Â
