I tried Botox to treat my migraines, here's how it went

The west of Ireland has a unique connection to Botox as a major global producer of the drug, but the substance, primarily known for banishing wrinkles, isn't solely utilised for cosmetic purposes. Its use as a medical treatment is now widely accepted. When Kate Brayden’s migraines worsened two years ago, she knew that it was time to go under the needle. When we think of Botox, our societal obsession with youth might initially come to mind; Hollywood stars in paparazzi photos with smooth foreheads that don’t move. The neurotoxic protein (Botulinum toxin) is especially interesting in an Irish context, given that the "Botox capital of the world" is none other than Westport, Co Mayo. In 2023, Allergan Pharmaceuticals Ireland UC's manufacturing plant in the local town increased to a record €4.43 billion, according to the released accounts. Niche dinner party facts aside, Botox has also been used to treat various forms of pain conditions and disorders. It has been found to block chemicals that carry pain signals to the nerves around your head and neck, making it an effective pain management tool for myofascial syndrome, headaches, migraines, arthritis and chronic back and neck pain. The FDA approved Botox for migraine headaches in October 2010, giving Allergan clearance to begin marketing its drug to patients with a serious history of the condition. Chronic migraine is defined as having a headache on at least 15 days per month, with eight of these days featuring migraine symptoms, for at least three months. I first started receiving Botox for migraine in 2023, after a dental surgeon recommended it for my jaw pain and throbbing temple-based migraines. The cause of my migraine was linked to my long-term fibromyalgia, a chronic condition (presumed to be autoimmune) characterised by widespread musculoskeletal pain, fatigue, and cognitive issues. My experience with Botox While I have found relief from Botox, it is temporary and short-lasting. Given the cost of such a treatment, I can see how some choose to only undergo a few rounds before calling it a day. I received Botox injections both by an oral surgeon in a dental practice, as well as a pain consultant who focused on slightly different sites around my head and neck. In total, I have tried four rounds, with varying degrees of 'success' - though we all have different definitions. According to Dr Deborah Galvin, a Dublin-based Consultant Anaesthetist and Pain Physician: "Success is considered as a decrease in the frequency of migraine attacks per month, pain intensity, medication use, ER visits, and migraine-related disabilities. This includes sickness leave from work, reduced productivity at work, school and home. "If Botox does not sufficiently reduce migraines after two separate treatments, cessation should be considered." It's important to note the cost for most patients. I had to pay between €200 and €300 per round of Botox, which is not easily accessible to many pain patients, many of whom struggle to manage working with a chronic condition. In terms of side effects, I experienced the most common one reported by Dr Galvin: neck pain. "Neck pain is the most common side effect reported, occurring in four per cent of patients. Other frequently reported side effects include injection site pain (two per cent), eyelid drooping (two per cent), and muscular weakness (one and a half per cent). Botox has not been studied in pregnant and breastfeeding patients, so its safety has not been established in these groups." For anyone else cursed to keep a migraine diary, we all want to know the cause. "CGRP is a neuropeptide which is believed to be the main culprit driving migraines in many patients," Dr Galvin elaborates. "Over the last five years, different CGRP antagonist medications have been produced, which are now the first line in the prevention of migraine. "The most recent CGRP antagonist, Rimegepant, has been available in Ireland as a high-tech medication since February 2025. This is an oral medication." What to try before Botox Botox is not typically used as a first line of treatment. A full clinical history and examination are important to ensure a correct diagnosis of a migraine is given. Medications are used to prevent migraines or to help with the acute pain during a flare - triptans, CGRP antagonists, ergot derivatives, beta blockers and antidepressant medications are all options. Dr Patrick Treacy, Medical Director at the Ailesbury Clinic, reports a multi-step approach before Botox: "First, identify and manage triggers—stress, diet (caffeine, chocolate), sleep disturbances, or hormonal factors. I also assess for rare but critical conditions, such as a patent foramen ovale (hole in the heart).To ensure safety, I require each new patient to undergo a brain MRI to rule out serious causes of headache, such as a brain tumour." 50 to 60 per cent of Dr Galvin’s migraine patients report noticeable improvement in migraine frequency after Botox, while often taking other migraine medications in parallel. Dr Treacy noted similar rates of success at the Ailesbury Clinic. Their audits showed that over 90 percent of patients had at least a 70 percent reduction in headache days after 12 months. Why Botox? Why Botox works for some migraine sufferers, but not others, remains disputed. "Botox is used to treat certain types of migraines, such as chronic, episodic, unilateral and vestibular types, with success depending on the type of migraine the person has," Dr Galvin tells me. "Frequently, patients have not found relief from beta blockers or antidepressants. Relief lasts up to 12 weeks with a possible worsening of headaches for the initial 10-14 days. "Effectiveness of Botox depends on the cause of migraine in the patient," Dr Galvin adds. "Certain proteins produced by neurons cause increase or decrease in the nerve signalling and the subsequent muscle, nerve and blood vessel behaviour. "Depending on what drives migraine in a patient, Botox may be more or less effective. Also, if Botox is administered too frequently (typically more frequently than every 12 weeks), antibodies are created by the body which neutralise Botox - rendering it useless and not effective." The reasons why Botox often improves symptoms of chronic migraine are not entirely certain, though medical practitioners like Dr Treacy have some ideas. "The precise mechanism of Botox in migraine relief remains partially understood, but it likely blocks pain signals by inhibiting neurotransmitter release (e.g., glutamate, CGRP) in peripheral nerves, reducing central sensitisation," Dr Treacy says. "Why it works better for some is multifaceted. Patients with clear chronic migraine, rather than mixed headache types, respond better, underscoring the need for accurate diagnosis. "Genetic factors, differences in pain pathways, or coexisting conditions like medication-overuse headache may influence outcomes. Injection technique and practitioner experience are critical—precise targeting of trigger points, as refined in my original protocol, is essential. It’s likely a combination of biological and technical factors." Final thoughts For anyone else who reached the end of their tether with migraines, I recommend finding a neurologist or pain doctor whom you trust wholeheartedly. Running all kinds of tests to rule out anything too scary and trying other medications first, though time-consuming and riddled with side effects, is also necessary before looking at Botox. For me, acupuncture with cranial neck massage helped temporarily, as well as pairing lifestyle factors with managing stress. Swimming and saunas, more time to relax and no more chocolate were key for me. Lastly, if Botox isn’t entirely effective, don’t lose hope. There are alternatives out there to try, like CGRP inhibitors and new medications in the pipeline. The hardest part is finding the right doctor to manage the condition with you. The views expressed here are those of the author and do not represent or reflect the views of RTÉ. Please speak with your GP or visit HSE.ie to learn more about treating migraines.

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