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Three Rounds of Botox May Be Necessary to Get Relief

If you tried one round of Botox and it wasn’t effective for you, you may still get relief after having a second or third round of injections, according to a recently published study. The study reviewed the experience of 688 people with chronic migraine who tried Botox.

Reduction in the number of headache/migraine days: After the first round of injections, 49.3% of patients had a 50% or greater reduction in the number of headache/migraine days during the 12 weeks the treatment lasts. Another 11.3% had success following their second round of injections, and 10.3% did after the third time they received Botox.

Reduction in the cumulative hours of headache/migraine: 54.2% of the original 688 also reported a 50% or greater reduction in cumulative hours of headache/migraine. 11.6% reached that level of relief after their second round of injections and another 7.4% did after their third round.

Headache Impact Test (HIT-6) score reduction: In addition, 56.3% of patients had a their Headache Impact Test score reduced by five or more points. After the second injection cycle, an additional 14.5% had that degree of improvement, and 7.7% of patients did after the third.

Although doctors and patients have been aware of the possibility that more than one round of Botox is necessary for relief, it’s helpful to have a study supporting this notion. It will help more doctors learn how to use Botox most effectively and can help convince reluctant insurance companies to cover the expensive treatment.

Before your first set of injections, talk to your doctor about the possibility of trying two or three rounds of injections before deciding Botox doesn’t work for you. Even if you don’t notice an improvement in your first or second cycle, you should keep to the 12-week schedule for frequency. Having your doctor (and insurance company) onboard ahead of time will save you some hassle (and possibly money) in the long run.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1. Silberstein, S. D., Dodick, D. W., Aurora, S. K., Diener, H. C., DeGryse, R. E., Lipton, R. B., & Turkel, C. C. (2014). Per cent of patients with chronic migraine who responded per onabotulinumtoxinA treatment cycle: PREEMPT. Journal of Neurology, Neurosurgery & Psychiatry, jnnp-2013.


  • WendyL
    4 years ago

    Just a warning when getting Botox if you have neck pain during migraines, that it causes extreme neck pain as a side effect. It is listed as a side effect in the website but the doctor that gave me the shots did not warn me. The pain was worse then any migraine I have ever experienced and it lasted a month.

  • Perez Joseph
    4 years ago

    One of the things I always find missing when people talk about botox treatment are the downside side effects (which is some cases are permanent). I’ve tried botox when it first came out (before the 32 injection protocols were adopted) and it didn’t do anything. However, I have 24/7 Chronic Intractable Migraines. One common side effect is the loss of your hair. To get more information log on to Amazon’s Blog Botox-Hair Loss to see others results. I probably get 5 new posts a week on this issue and inspite of them trying to get their back using Rogain, etc. The hair stays gone (but thats what wigs are for I suppose). I’ve been searching to something to deal with my migraines for 10 years now and I hoped that botox would work-but after a neurosurgeon injected lidocaine in a number of places in the back of my skull and neck, there was no relief, so it was felt that botox wouldn’t do much for me. But I’m very happy for those for whom it works. I just haven’t found my trigger(s) yet-and I can’t take tripans due to my heart problems. I hope it works for you.

  • BBalla
    5 years ago

    As I prepare for my third round of Botox, I can only hope that the third time is a charm! The first two rounds did nothing at all. After reading your article, I have renewed hope that perhaps there is still hope!

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