Increased migraines after Botox?

Hi - So sorry to hear you've had an uptick in your attack frequency since your botox injections. Good of you to seek counsel from your doctor regarding this. I have heard doctors say that they encourage folks to stick with various approaches for 2 to 3 trials before making a final evaluation regarding efficacy. That said, if you are having a very clear and negative response, I could see how sticking to it - and going for another round would be difficult to do.


I think one of my colleagues may have already sent you this link on another thread, but I'll send it here just in case: https://migraine.com/video/20-years-of-botox. I've been receiving botox injections for over 20 years. Sometimes the injections are different and less effective than others. That said, I've never had an instance in which my attack frequency increased. Sometimes it has been less effective or caused troublesome side effects, but never an uptick. I will say the efficacy of Botox can vary due to the level of experience of the practitioner and where they choose to inject you. Do you know if the person who injected you is well-experienced? Did you have a negative experience or any troublesome side effects during or right after the injections?

There have been others in our community who've reported a worsening in their attacks after trying Botox. If you enter "botox worse" into the search bar above left you will see some stories of those who have shared your experience. There aren't an overwhelming number, but you're not alone.

We are each so unique in what works (and what doesn't) when it comes to migraine treatment options. Botox does not work for everyone. Thankfully there are many other migraine treatment options out there. Have you and your doctor discussed what you might try next? Do you feel good about your relationship with your doctor, by the way? I'm assuming you qualify as having chronic migraine (15+ attacks monthly) even though you have 7 attacks a month because of how long your attacks last- is that correct? (I realize this month you've had 15+ ) - this only matters as some of the available treatments are marketed (and insurers cover meds) for those who fit that specific definition.

We are here for you as you think all this through and consider your options. Please let us know how we can best support you. Warmly - Holly (team member)

Hello again- glad the video may have been useful to you. I think you are right to perhaps focus on the option that there may be other reasons for your uptick in migraine attacks during this window. That certainly would make it worth sticking with the treatment for another round.

And good for you for revisiting your numbers to carefully evaluate the efficacy of this treatment for you. My own numbers are tricky to track as I live with chronic migraine at a pace that means some level of migraine pain every single day. This makes it hard to track one attack from another. I therefore tend to pay more attention to the qualify of life that my treatments afford me. The best way I evaluate Botox is the dramatic way my attacks worsen in severity as the treatment loses its strength in the last weeks while I'm awaiting my next injections. It is a very obvious and significant worsening of symptoms during that window that helps me realize that Botox is working well to tamp down the severity of symptoms for the weeks preceding.

Regarding your relationship with your doctor- the reason I raise this is because the overall management of this challenging disease can hinge on what kind of partnership we share with our doctor. We generally encourage folks who are living with chronic migraine to pursue evaluation and treatment with a migraine specialist (these doctors have been trained especially in the complex neurological disease that is migraine): https://migraine.com/living-migraine/how-to-evaluate-doctor. That said, neurologists and general practitioners can be wonderfully resourceful as well. It's up to you to evaluate your connection. You want to be sure your doctor is responsive (and hopefully doesn't have too long of a wait for appointments- but even if so, will respond by email or phone in the meantime to your questions), respectful, non-judgmental, and sees you as a key partner in your own care. In case you are interested, we can give you referrals to migraine specialists. Please let me know if so.

We are here for you and do commiserate with what you are facing. You are not alone in facing these challenges and we are so glad you are with us sharing what you have learned and continue to learn along the way. You are helping to strengthen our community with your insights. Please stay in touch. I'll be interested to hear what you decide regarding continuing to proceed with botox vs. trying something else instead. Warmly - Holly (team member)

Since you were asking Holly about her experience with Botox, I'm going to tag our other colleague who also currently uses Botox as part of her treatment routine. All the best for you, especially as you try to navigate the six-month wait to get treatment. That's brutal! -Melissa, team member

well hi again! You actually live in my area! There’s a practice right there in Durham with two or three migraine specialists. It’s called the Carolina headache Institute. I would encourage you to start with them, but I’ll circle back and give you a couple other recommendations when I’m back in front of my computer. I think there are other specialists in Raleigh as well. Warmly - Holly (team member)

thank you!!

Hi there- I'm circling back to say that unfortunately, it seems Dr. FInkel is no longer seeing new patients. I do think Dr. Kahn is, however. Again, I'd suggest seeing if you can get an appointment before your next Duke appointment to compare and contrast to decide which you might like better. Let me know if you're able to get through there and what you think, if so. Warmly - Holly (team member)