Hi susanmartinez,
Thank you for reaching out to us! Let's see what information I can give you.
Actually it may take two to three rounds before we notice a reduction in migraine attack frequency and severity. Many of us who stick with Botox see our abortives (sumatriptan) work better. If you haven't seen this information on Botox, take a look when you get a chance; https://migraine.com/blog/botox-basics/.
Taking migraine medications (sumatriptain) and/or pain relievers, whether they are over-the-counter or prescription, more than two to three days a week can create another problem called rebound headache, or medication overuse headache. If we're in a rebound cycle our migraine attacks will be more difficult to treat and we can end up in a daily cycle of endless pain that too is hard to break. Here is information on rebound; https://migraine.com/living-migraine/stop-rebound-headaches/.
If the neck and back pain is connected (I'm not sure they are) to Botox, that should go away as the drug wears off. You mentioned you are getting "middle of the night" migraine attacks, so this isn't new? This should be discussed with the doctor as getting an accurate diagnosis is important in getting the proper treatment. I'll share this article with you on hypnic headache, commonly referred to as 'alarm clock' headache; https://migraine.com/living-migraine/nighttime-headaches-after-age-50/. This type of headache disorder typically occurs in people over 50, but there are always exceptions to the rule!
The pulsing you mentioned could be part of the first phase of a migraine attack called prodrome. There are four phases of a migraine attack, but not everyone will experience each phase; prodrome, aura, headache and postdrome. Let me share this information of the four phases; https://migraine.com/infographic/the-four-phases-graphic/.
I hope this helps, let me know what you think?
Nancy