The Benefits of Using Xeomin and Botox to Treat Chronic Migraines
JANUARY 2023 | Dr. Ashley Southern
Chronic migraines can be debilitating, affecting approximately 10% of the world’s population; “chronic migraines” are defined as migraines that occur on 15 or more days of the month for 3 or more consecutive months. There are many theories to what causes a migraine – although it is still largely unknown – and there are several factors that could explain causes an episode. The most common factors include excessive caffeine consumption, obesity, sleep apnea, depression, anxiety, and medication overuse. Regardless of what causes them, it is safe to say that between their frequency and intensity, chronic migraines can significantly impact one’s quality of life.
Medications like non-steroidal anti-inflammatory drugs (NSAIDs), triptans, and some antiseizure medications have seen success in treating and preventing episodes for some people. However, in the case of chronic migraines where episodes last for more than 15 days, the amount of medication required to help manage the pain can add up. Considering that drug overuse is an underlying factor of chronic migraines, reliance on these types of medications can potentially create a self-perpetuating cycle that could result in more migraines, tolerance build up, and dependency.
Fortunately, there are alternative, medication-free treatments available that can help to alleviate and prevent migraines from occurring, gifting those who suffer from chronic migraines their life back. Research has shown that botulinum toxin A therapies like Botox and Xeomin are not only safe, but significantly effective for treating chronic migraines.
How Does Botox and Xeomin Work to Treat Chronic Migraines?
While there is still research conducted on the root causes of migraines, it is generally accepted that they are a result of abnormal brain activity and reaction to certain stimuli, which temporarily affect the chemicals, blood vessels, and nerve signalling between the brain and the nervous system. The brain takes in the abnormal stimuli, processes it, and then sends out its response to the body via the central nervous system. Our muscles then receive this signal and perceives it as pain.
Botulinum toxin A therapies like Botox and Xeomin are categorized as neuromodulators, meaning they alter nerve transmission. They work by cutting off the pathway of neurotransmissions from the brain between the muscles and the nerves that receive these transmissions, blocking communication between the brain and body at the level of where the nerves and muscles meet in the injected area.
During a migraine, the brain releases specific neurotransmitters our body interprets as a painful stimulus. Research has shown that when Botox or Xeomin is injected into the muscles of the face, neck, and head, the active botulinum toxin A ingredients interrupts these pain transmissions and prevents the signal from telling your brain about the pain. In this way, Botox and Xeomin works to suppress the peripheral and central nervous system to various stimuli, making them effective analgesic treatments.
Studies have also shown Botox and Xeomin can help to alleviate tension headaches as well because they are effective muscle relaxers. They inhibit the release of acetylcholine from peripheral nerve endings, which suppresses the peripheral and central nerve responses. Without any signal telling the muscle to respond to stimuli and contract, the muscle is allowed to relax. As the muscle relaxes, tension is released. Tension reduction decreases stress on the nervous system, and helps to alleviate the severity of the headache, or even prevent tension headaches entirely.
How Effective Are They for Treating Chronic Migraines?
In 2010, the U.S. Food and Drug Administration (FDA) approved Botox, Xeomin and other botulin toxin treatments like Dysport and Mybloc for treating migraines. Since then, even more research has come out supporting just how beneficial and effective they are for helping to manage chronic migraines. A more recent study on Xeomin that looked at migraine episode frequency as well as pain medication intake showed that 73% of migraine patients saw a >50% reduction in the frequency of episodes. Of those who experienced a decrease in frequency also reported a decrease in drug intake by approximately 50% after 2 years of Xeomin treatments. The study also showed that Xeomin had beneficial impacts on patients who experience other types of migraines including isolated episodic disabling migraines, medication overuse headaches, and tension-type headaches (Ion I, 2018).
What to Expect from Treatments
Typically, both Botox and Xeomin treatments last between 20 – 40 minutes and are minimally invasive, requiring no down time and minimal recovery. While some pain or swelling at the injection site can be expected, most people return to regular activities immediately following their appointment. While it may take up to 4 weeks and routine injections to see optimal benefits, most people experience reduction in their migraine or headache symptoms after the first treatment. After the second treatment, Xeomin has been seen to prevent up to 9 migraine days a month (Basel, 2020).
It is important to know that both Botox and Xeomin are temporary treatments and may not stop migraine episodes entirely. In some cases, patients reported a complete cessation of migraines and were able to discontinue treatments. For others, routine injections may be required to maintain symptom relief. Repeat treatments are recommended every 12 weeks.
Would I Benefit from Botox or Xeomin for Chronic Migraines?
Treatments are typically recommended for qualifying adults over the age of 18 who experience chronic migraines. Botox or Xeomin therapies are most beneficial for those who:
- Have tried other prophylactic interventions including pharmacotherapy, behavioral therapy, or physical therapy without symptom improvement
- Experiences 15 or more tension headaches or migraines over the course of 3 months
- Have tried other migraine-preventative medications without symptom improvement
Neither Botox nor Xeomin is recommended for those who are pregnant or breastfeeding. It’s also important to do your own research and to thoroughly discuss with your healthcare provider whether Botox or Xeomin is the right treatment for you. To learn about the pros and cons of botulinum toxin type A treatments, read more about Everything You Need to Know About Botox and Xeomin.
References
Ion I, Renard D, Le Floch A, De Verdal M, Bouly S, Wacongne A, Lozza A, Castelnovo G. Monocentric Prospective Study into the Sustained Effect of Incobotulinumtoxin A (XEOMIN®) Botulinum Toxin in Chronic Refractory Migraine. Toxins (Basel). 2018 Jun 1;10(6):221. doi: 10.3390/toxins10060221. PMID: 29857565; PMCID: PMC6024863.
Becker WJ. Botulinum Toxin in the Treatment of Headache. Toxins (Basel). 2020 Dec 17;12(12):803. doi: 10.3390/toxins12120803. PMID: 33348571; PMCID: PMC7766412.
