Chronic Migraines

Chronic Migraines

As a Chronic Migraine sufferer, you likely experience headaches a number of days each month, and these headaches likely last for hours at a time. Your doctor may have prescribed BOTOX® to help prevent these headaches. The following information may help if you are considering  BOTOX® for the management of your chronic migraine headaches.

Reasons to Consider Botox for Chronic Migraines

  • Chronic Migraines are debilitating: People with Chronic Migraines experience 15 or more days a per month with headache lasting 4 hours a day or longer.
  • 4 times as many chronic migraine sufferers missed a significantly higher number of family  activities, work or school vs those with episodic migraine over a 3-month period.
Botox make a difference:  Approximately 70% of patients treated with Botox experienced more than a 50% reduction in headache days from Baseline at week 56 in a clinical trial.
  • Botox is Convenient:  The recommended Botox treatment schedule is once every 12 weeks.
  • 90.3% of claims are approved for coverage by private insurers.  

    • What is Chronic Migraine?
      Chronic Migraine is defined as:  Migraine with 15 or more headache days per month over the past 3 months, of which at least 8 headache days meet criteria for migraine without aura. To meet the criteria for migraine without aura, the migraine sufferer will be experiencing two of the following symptoms:

      • The headache is on one side of the head only.
      • The headache has a throbbing or pulsing quality to it.
      • The headache is moderate to severe in pain intensity.
      • The headache is aggravated by or causes avoidance of physical activity and is accompanied by one of the following: nausea and/or vomiting or sensitivity to light or sound.  And/or
      • The migraine sufferer will have treated or relieved their headache with migraine medication prior to the expected development of the symptoms listed above.

      How is BOTOX® administered?
      BOTOX® is injected by needle into 31 to 39 sites in 7 specific head and neck muscle areas. These areas may be contributing to your headaches. Your doctor will determine the number of injections and injection sites required to treat your specific condition.  The recommended dose of BOTOX® is 155 units in 31 sites. If your doctor thinks it is necessary, he or she may decide to inject up to 40 additional units of BOTOX® into three specific muscle groups for a total maximum dose of 195 units.


        What is Chronic Migraine?
        Chronic Migraine is defined as:  Migraine with 15 or more headache days per month over the past 3 months, of which at least 8 headache days meet criteria for migraine without aura. To meet the criteria for migraine without aura, the migraine sufferer will be experiencing two of the following symptoms:

        • The headache is on one side of the head only.
        • The headache has a throbbing or pulsing quality to it.
        • The headache is moderate to severe in pain intensity.
        • The headache is aggravated by or causes avoidance of physical activity and is accompanied by one of the following: nausea and/or vomiting or sensitivity to light or sound.  And/or
        • The migraine sufferer will have treated or relieved their headache with migraine medication prior to the expected development of the symptoms listed above.

        How is BOTOX® administered?
        BOTOX® is injected by needle into 31 to 39 sites in 7 specific head and neck muscle areas. These areas may be contributing to your headaches. Your doctor will determine the number of injections and injection sites required to treat your specific condition.  The recommended dose of BOTOX® is 155 units in 31 sites. If your doctor thinks it is necessary, he or she may decide to inject up to 40 additional units of BOTOX® into three specific muscle groups for a total maximum dose of 195 units.

        Are there any side effects?
        In general, the following have been reported in association with BOTOX® treatment: pain, tenderness and/or bruising at the site of injection. Malaise (generally feeling unwell) lasting up to six weeks after injection with BOTOX® has also been reported. In addition, weakness, changes in the way the heart beats (reported rarely), chest pain, skin rash or allergic reaction (symptoms: shortness of breath, wheezing or difficulty breathing, swelling of the face, lips, tongue, or other arts of the body, rash, itching, or hives on the skin), anaphylaxis, cardiovascular events, seizures, dysphagia, and respiratory compromise may occur in association with BOTOX®. 

        The following events have been reported rarely (<0.1%) since BOTOX® has been marketed: skin rash, itching, allergic reaction, and facial paralysis. There have also been rare reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors,  including cardiovascular disease.2 In patients being treated for Chronic Migraine in clinical trials, the following side effects were commonly reported: headache, facial muscle weakness, drooping of the eyelids, muscle spasm, muscle tightness, injection pain, and rash.

        What might I experience after treatment? 
        You may experience pain or inflammation in a muscle or muscles that have been injected with BOTOX® . You may also experience bleeding, swelling, or bruising in the area injected.

        When should BOTOX® not be used?

        • BOTOX® should not be used in patients who are hypersensitive to botulinum toxin type A or to any ingredient of BOTOX®
        • BOTOX® should not be used when there is an infection in the muscles that would normally be injected.
        • BOTOX® should not be used in patients with any muscle disorders in other parts of their body, including myasthenia gravis, Eaton Lambert syndrome, or amyotrophic lateral sclerosis.
        What should I talk to my doctor about before receiving BOTOX® injections?
        Before receiving BOTOX® talk to your doctor  if:
        • You have myasthenia gravis, Eaton Lambert syndrome, amyotrophic lateral sclerosis or another muscle disorder.
        • You are allergic or sensitive to BOTOX®
        • You have an infection at a proposed injection site.
        • You are scheduled to have surgery using a general anaesthetic.
        • You are taking or are likely to take antibiotics, especially aminoglycoside antibiotics.
        • You are pregnant or may become pregnant while being treated. Repeated doses of BOTOX® given to rabbits during pregnancy have caused abortion or fetal malformations.
        • You are nursing. It is not known whether this drug is excreted in human milk, but many drugs are excreted in human milk.

        How do I make an appointment at the Therapeutic Botox Centre?
        First, your family doctor or neurologist must diagnose you as a chronic migraine sufferer using the above mentioned criteria.  If your doctor thinks therapeutic BOTOX® is an option, he can refer you for a consultation by filling out the Referral Form which you can download. You may bring this filled out form with you or your Doctor can fax it to our office prior to your consultation.  It should detail your history as well as any previous treatments you have tried that have been unsuccessful.   If you have obtained your referral letter directly, you can call us to book an appointment.

        What are the costs associated with a BOTOX® Migraine Treatment?
        The initial consultation is covered by the Ontario Health Insurance Plan. So please bring your health card.  Most private drug plans cover the cost of medication (the BOTOX®) which represents about 80% of the total cost of treatment.  A fee of $250 is charged for the injection procedure, physician time and supplies. This is generally not covered by private drug plans.

        Referral Form for Doctors