Botox Treatment for Chronic Migraine Headaches

OnabotulinumtoxinA (Botox) is a medicine used to treat chronic migraine headaches to help make them less severe and less frequent.

To give the treatment, your child’s healthcare provider uses a needle to inject a very small amount of Botox into 30 or more spots on your child’s head, neck and shoulders.

We may recommend Botox treatment if your child:

• Has chronic migraines (15 or more headache days per month for at least 3 months)
• Has tried at least 2 to 3 preventive oral medicines for several months that have not made their headaches better, such as topiramate (Topamax), amitriptyline (Elavil) or propranolol (Inderal).

We believe Botox for chronic migraines works by changing how the nerves in the muscles of the head and jaw carry pain messages to the brain.

• Your child should start to notice fewer headaches 7 to 14 days after the Botox injections. It should last about 12 weeks.
• If the injections help your child, they can get repeat injections every 12 weeks to keep headaches away.
• If your child does not experience fewer headaches after the first treatment, they can repeat the treatment 12 weeks after the first injections. Some children will experience fewer headaches only after the 2nd or 3rd treatment.

Botox for chronic migraine treatment was approved in 2010 by the FDA (Food and Drug Administration) for people 18 years and older. It has been used as a treatment for people under 18 for years, although this has not been approved by the FDA. This is considered an off-label use.

Botox works near the injection sites, so it usually does not cause side effects that affect the whole body. When there are side effects, the symptoms are usually mild. Some possible side effects are:

• Pain at the injection site. This pain should only last a few minutes.
• Worse head and neck pain for a few days after the injections. You can usually treat this with anti-inflammatory medicines like ibuprofen (Advil, Motrin) or naproxen sodium (Aleve). Do not lift heavy things or carry a backpack until symptoms improve.
• Droopy eyelids for up to 12 weeks.
• Weak chewing and neck muscles for up to 12 weeks.

If you would like your child to have Botox injections to treat chronic migraine, follow these steps:

1. Talk to your neurology provider about Botox to prevent migraines.
2. Talk to your insurance company about what costs they will cover. Even if Botox is covered by insurance, you may have to pay extra charges for this treatment.
3. After you and your neurology provider decide to go ahead with Botox treatment, it may take about 1 month for your insurance company to approve or deny the medicine. So, we schedule the 1st Botox treatment at least 1 month after the visit when we ordered the Botox.
4. Your child’s healthcare provider may need to write a letter of medical necessity to your insurance company.
5. We will not do the 1st Botox treatment until we have insurance approval.
6. Clear any issues, like outstanding balances, with your insurance company well before the planned injection visit. Any issues can delay your child’s treatment.

For any questions about scheduling and approvals, call our office coordinators 206-987-2078 or contact your insurance company.

• If your child is nervous about the treatment, ask us about options to help them feel more comfortable about the injections. We can arrange to have other services (we call it Child Life) available to assist with stress-reduction during the procedure. Please let us know if you think a Child Life Specialist could help your child.
• For age-specific tips to help prepare your child, see our webpage “Your Child’s Clinic Visit: Preparing Your Child.” Scroll down to Tips for Preparing Your Child.
  seattlechildrens.org/preparing-your-child
• Here are links to more information about Botox for chronic migraine from the American Migraine Foundation:
  americanmigrainefoundation.org/resource-library/faq-botox-for-migraine