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Botox Often Helps, but Keep Expectations Realistic

Q: My wife has chronic migraines, and we are looking at Botox®. What does your research or experience tell you about Botox for migraines?

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 of less than 15 headache days per month. In my practice, I administer Botox injections on an almost daily basis. Most, but not all, patients receiving Botox experience a reduction in the number and frequency of their attacks. Although some patients become headache-free, this result is unusual and should not be expected.

If you receive Botox therapy, plan on getting at least three treatments at three-month intervals.  In my experience, Botox, if not effective after three treatments, is unlikely to help. However, Botox should not be abandoned if the first injection fails to achieve the necessary response. Botox does not interact with the usual preventive headache medications, so those drugs can be continued during the duration of Botox therapy.

Mark W. Green MD, FAAN
Director of Headache and Pain Medicine
Mount Sinai School of Medicine
New York, NY

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