Q: My wife has chronic migraines, and we are looking at Botox. What does your research or experience tell you about Botox for migraines? —Trent M.
A: Botox was approved by the FDA for the treatment of chronic migraine in late 2010. Interestingly, it has not been shown to be effective with a frequency lower than 15 headache days per month. I inject Botox almost daily in my practice. Most, but not all, people experience a reduction in the number and frequency of their attacks. Although some become headache-free, this is unusual and should not be expected.
If you use Botox, plan on getting three treatments three months apart. My experience is that if it’s not effective after three treatments, it’s unlikely to help. But it should not be abandoned if the first treatment fails. Botox does not interact with the usual preventive headache medications, so those can be continued during the time the Botox is administered.
Mark Green, MD, Mount Sinai School of Medicine, New York City
