Episodic vs. Chronic Migraines

A bad headache can ruin your day. But chronic migraine headaches that include sensitivity to light, noise and smells can significantly affect your daily life. The pain and nausea can be debilitating and reduce your productivity at work and affect the time you spend with family and friends.

When you have headaches 15 days or more a month—with at least half of those headaches being migraines—you have chronic migraines. About 10 percent of the general migraine patient population, that’s 4 million people, suffers from chronic migraines. Episodic migraines occur less frequently—15 days or less a month. 

Typical Migraine Treatments Compared to Botox

According to Dr. Stephen Landy, director of Baptist’s Headache Clinic and clinical professor of neurology at the University of Tennessee Medical School, before Botox treatments were approved, doctors used antihypertensive, anticonvulsant or antidepressant medications to treat and prevent chronic migraines. The effectiveness of these medications, though, varied with each patient and often caused side effects.

In 2010, the Federal Drug Administration (FDA) approved Botox as the first drug specifically for treating chronic migraines.

“The fact that there is another treatment option for the most disabled of migraine patients is a really good thing,” said Dr. Landy. “Eight years after receiving FDA approval, Botox does quite well for this difficult-to-treat population.”

Botox as a migraine treatment results in little to no side effects for patients. The treatment also significantly improves patients’ quality of life. The addition of Botox as a treatment option helps doctors and medical professionals improve overall care to their patients.

“Botox increased the level of understanding of chronic migraines, differentiating it from episodic migraines,” said Dr. Landy. “Now with the appropriate diagnosis, Botox allows doctors to provide better care for these patients using an FDA-approved medication and specifically treating the condition they have.”

How does Botox for migraines work?

The current thought is that Botox, a form of botulinum toxin, prevents migraines by inhibiting release of neuropeptides that cause migraine headache. The treatment consists of 31 Botox injections into seven muscles of the face, head and neck. The doctor uses small needles to make these injections. The total appointment takes about 15–20 minutes.

Whether there is a noticeable decrease in migraines, the patient receives at least two treatments scheduled 12 weeks apart. It is worth noting, the treatment may take time to work, and doctors often recommend patients wait until after the second or third treatment to determine if it’s effective.

Some patients may continue treatments every 12 weeks. However, after a year or two, some patients experience significant improvements and a reduction of migraines. As migraines become more infrequent, the period between treatment cycles is extended and, for some, eventually tapered off.

“The effectiveness of Botox to treat chronic migraines continues to be proven,” said Dr. Landy. “A recent study shows a decrease in headache days among chronic migraine patients who receive Botox treatments for two years. It’s possible patients using Botox respond better and better the longer they use it.”

Who qualifies for Botox for migraine treatments?

Patients who have been diagnosed with chronic migraines qualify for Botox treatments. A doctor or specialist will evaluate past treatments to determine if Botox is an appropriate option. Documentation of a chronic migraine diagnosis and past migraine treatments is necessary to receive insurance coverage.

Typically, insurers require patients to have tried at least two other chronic migraine medications or treatments that proved ineffective before covering Botox. A process known as prior authorization properly documents a chronic migraine patient’s diagnosis and past treatments for insurance providers. After prior authorization has been received, a patient then qualifies for insurance coverage for Botox treatments.

Learn more about Botox for migraines and neuroscience services at Baptist. Find a Baptist doctor by visiting our Find a Physician page.