Why Didn’t Botox Work For My Migraine Headaches?

Q: Dr. Eppley, I was treated by a “#1 Migraine Specialist” in my state. I had been seeing this Dr. for 1 yr. and 4 months before he suggested Botox and I finally did the treatment because my insurance paid for it! YAY! I finally did the treatment in November 2012 and it was so painful! There was no spot left untouched. It helped the headache I had then so I was sure it was going to prevent the future ones! And low and behold just days later I get a Migraine and been having them as usual! I never had migraines until I had my stroke on May 10, 2010. When I get them they stay until i have to go to the emergency room for relief. Ten dr.’s later and I still have no relief. I have taken over 50 different types of meds and STILL NO RELIEF! I am so disappointed! I cannot live like this anymore! What can I do???

A: I am so sorry to hear about your terrible migraine history and current condition. Just based on your description I comment on your Botox experience. First, it should not have been that painful. When skillfully done wirth a small 30 gauge needle, it is at best of minimal discomfort. Secondly, when Botox is used for migraines it is not done ‘all over the head’. It needs to be placed specifically into known trigger point areas of which there are three very specific locations. This does not sound like what was done. Whether you have the type of migraine headaches that may be improved by Botox is unknown…as of yet. I would suggest that you have the Botox injections repeated at the identified trigger points based on your headache pattern. This will the tell you if you may be a good candidate for surgical decompression which is what, as a plastic surgeon, I can offer for your potential migraine headache relief.

Dr. Barry Eppley

Indianapolis, Indiana