7 Things I wish Buzzfeed knew about Botox for Migraines (You’ll never believe #4!)
Brief disclaimer: I am not a doctor, and I have no medical training. No two people are exactly alike, so your mileage may vary and you should always discuss any changes to your health regimens with your doctor.
Last week, my husband and I were settled in to our nightly routine of perusing our YouTube subscriptions together — usually this means a lot of videos from Facts, the React Channel, All Def Digital, and my personal favorite, FailArmy. A while back, we also subscribed to Buzzfeed. We don’t watch as many of their videos as we used to (although we still love the Try Guys and Worth It), but every once in a while, one catches our eye. The other night, it was this one:
In it, the indomitable Becky Harris, who suffers from migraines, decides to try Botox to see if it will help. As a migraine sufferer who’s been using Botox for almost a year now, I was curious to see a peer’s experience. I’m always looking for solidarity in this fight.
But as I was watching, I found myself disappointed.
“That’s not the protocol,” I hissed, much to my husband’s amusement. “That’s not what my neurologist does at all.”
Becky is super inspirational, and I’ve been touched by her openness and willingness to share her struggles with alopecia, Vulvar vestibulitis syndrome (VVS) and now migraines. So many times watching her videos I’ve just wanted to reach through the screen and hug her, hard.
And with this one, I wanted to tell her, “Becky, you’re doing it wrong!”
Not because I wanted to make her feel bad, or shame her, or anything like that. But because I wanted her to get better. And what I saw in the video wasn’t setting her up for that. What I saw in the video was a potential recipe for disappointing results, which could then in turn lead to her discouraging others from seeking it out (although I don’t think she would ever do that purposely, I can imagine someone watching, seeing it not work for her and deciding they wouldn’t pursue it themselves).
So, in the ‘clickbait’ headline style listicle that Buzzfeed has perfected, I present to you: 7 things I wish Buzzfeed knew about Botox for Migraines.
1: There’s a whole protocol (PREEMPT) of 31 injection sites in a standard, FDA-approved migraine Botox treatment regiment. Only 3 are on your forehead below your hairline.
When I saw Becky’s video and they marked out the spots for the Botox, I got very concerned. They marked twenty different injection sites, all on her forehead! The standard Botox for Chronic Migraine regimen has only seven injection sites on the front of the head, and only three below your hairline. The rest are spread throughout the temples, back of the head, neck and upper shoulders.
The first time I got Botox, I expected them to all be along my hairline, but I realized that the temples, neck and shoulders are all super important spots as well. For me, my migraines always come with a stiff neck and shoulders, and usually a good deal of the throbbing will happen both in my temples and actually behind my eyes (side note: I am so glad there is not a ‘behind-the-eye’ injection site — this is actually handled with the temple injections).
2: Botox for Migraine is administered every 12 weeks. Getting one round of Botox isn’t going to magically cure a person of migraines. This is something that you’re going to have to do potentially for the rest of your life (although, especially in women, hormonal changes like pregnancy and menopause have been known to help sometimes). Just like cosmetic Botox, eventually the toxin is metabolized by your system and its benefits wear off. That being said, you should also know…
3: It can take 2–3 rounds of Botox to see any sort of major improvement. While I’m really glad that Becky noticed immediate improvement, that’s actually not the norm. For most people, it takes around 2–3 rounds, and sometimes up to 6, before they start noticing much of an improvement. For me, there was some immediate benefit during the first round, but not enough for me to be below the threshold of 15 migraine days per month (more on that later). I’ve gone through five rounds now, and still have approximately 2–3 migraine days per month — which is an insane improvement — and my neurologist and I are working to get that down the magical ZERO through adjustments to the protocol (a little more injected into my neck and temples).
4: If done properly, the protocol has very little effect on your appearance. Because of the locations of the injections, Botox for Migraine doesn’t really affect your appearance. I have noticed a missing wrinkle between my eyebrows (RIP Forehead Crinkle, 1986–2016), and I had a bit of a fierce eyebrow period after one set of injections, but my neurologist adjusted her injection sites ever so slightly and since then the effects are pretty minor (but Forehead Crinkle is still lost). I still have all my lovely lines across my forehead and, as much as my coworkers like to tease me about facial paralysis, I can still make all the necessary facial expressions.
5: The protocol is administered by a neurologist, specifically one who is a headache specialist, not a dermatologist. This also affects #4, above. There is specific training given to headache specialists on how to properly inject Botox to have the best chance of success and minimal side effects such as appearance changes, droopy eyebrows and bruising. Dermatologists, on the other hand, are trained to inject for cosmetic reasons, and untrained neurologists may not have the expertise to inject in the right place with the right pressure.
6: Botox for migraine is FDA-approved for people with chronic migraine, meaning at least 15 headache days a month. If you get a migraine now and then, you probably don’t need to even think about Botox. You (and your wallet) are probably better off just sticking with an abortive treatment like Imitrex (sumatriptan) or Maxalt (rizatriptan). Even for someone like myself, Botox was never brought up until I had more than 15 days with headaches per month; back when I only had a migraine during my period, I just stuck to a low dose of Imitrex and it was fine (although always annoying to already be on your period and then have a debilitating headache).
7: Botox is not a cure-all. As my neurologist likes to remind me at every follow-up visit, it’s only part of the equation. You’ll probably still get ‘breakthrough’ migraines if you don’t identify and avoid your triggers. And it’s probably a good idea (ok, ok, I know it’s definitely a good idea, get off my back, Dr. B!) to get in the habit of eating well and exercising regularly. The good news is, since Botox can help get rid of at least some of the migraines on its own, you’ll feel like exercise is a little more possible!
So, those are my seven things that I wish Buzzfeed knew about Botox for Migraine. I really, really hope that Becky finds a headache specialist and continues on the path to relief from her migraines, and maybe we’ll get a follow-up video from her about it soon. In the meantime, if you’re thinking maybe Botox could help you, talk to your doctor and/or find a headache specialist. If it works for you as well as it worked for me, then it’s definitely worth 31 little pokes in your head every twelve weeks (and that’s coming from someone who has to sit in the fetal position pretty much every time!)