Sophia Cross had her first migraine at 12 years old.
First, she lost her vision, followed by severe head pain, fainting and an ambulance trip to the hospital. After several days at the hospital, she was ultimately diagnosed with chronic migraines.
“It was really scary. I had to take so many different types of medication. Every time I would get any kind of headache, I would have to medicate and then go right home,” said Cross, now a first-year commerce student at Dalhousie University. “It was really hard for my friends to understand what I was going through.”
After every medication, remedy and therapy available came up short, it was time to try something new.
“They were basically like, ‘the only option left is Botox,’” Cross said. Braving her fear of needles, Cross went to her first appointment in 2022 at age 15.
“I was mortified,” Cross said, who went through consultations, a risk assessment and an eye exam before laying down for her first session.
But she said the results were immediately noticeable.
“It was life-changing,” she said. “I have not had a migraine since my second round of Botox and I’ve had eight rounds of Botox.”
Botox is the beauty industry’s biggest hit. It’s known for smoothing out wrinkles and seemingly stopping aging in its tracks. However, Botox is increasingly becoming a more versatile medical solution to a plethora of different issues.
Botox is a brand name for botulinum toxin type A, a neurotoxin that temporarily weakens or paralyzes muscles by blocking nerve signals that tell them to contract. Therapeutic Botox, the kind used medically, is now being used for a variety of medical conditions, including migraines, spasms, excessive sweating and an overactive bladder.
Botox was slowly discovered as a migraine treatment in the 1980s through 2000s after people receiving it for cosmetic purposes reported reduced headaches. Health Canada approved the injectable as a treatment for chronic migraines in 2011.
Migraines result from genetic and environmental factors, including responses to stress, hormonal shifts, medications, jaw issues and more.
According to advocacy and research organization Migraine Canada, experts estimate that 12 per cent of Canadians experience migraines. Historically, treatments have included pain relievers, triptans and anti-nausea drugs. Now Botox is becoming a more common addition to the list.
Treating migraines with Botox is typically only suggested to people with chronic migraines, meaning those with 15 or more headaches a month, with at least eight of those days with a migraine.
Dr. Haissam Dahan, who runs Ottawa TMJ and Sleep Apnea Clinic, is an expert and researcher in facial pain and sleep dentistry. Dahan uses Botox to treat migraines resulting from jaw issues at his clinic.
Like Cross, most people resort to Botox only after trying a variety of other treatments and therapies. Dahan admitted the injection procedure can be intimidating, but it’s often the relief many patients need.
“It’s never the only treatment but sometimes it’s the one thing that makes the biggest difference for people,” Dahan said.
Botox treatments for migraines typically occur every 12 weeks and include 31 to 39 individual injections per session. The average amount of treatments received can vary significantly and depends on the patient. Injections are site-specific and can be administered at the face, neck, head and shoulders.
“It’s a few injections in specific targeted sites,” Dahan said. “The whole procedure takes about 15 minutes.”
For many, cost is a key consideration when deciding whether to pursue Botox for migraines. Insurance plans often cover all or some of the cost of therapeutic Botox. However, uninsured patients may pay anywhere from $300 to $2,000 per session.
The rise of cosmetic Botox
The beauty industry heavily promotes Botox as an anti-aging treatment, with celebrities and online personalities showcasing results. The exposure has made Botox a mainstream trend, with more than 8.8 million procedures worldwide in 2023, making it the most popular non-surgical procedure.
While this popularity sometimes overshadows its medical applications, it’s also helped bring awareness to the therapeutic uses of Botox.
“When I first opened my clinic about 12 years ago, no one knew much of it, and now we get calls specifically for it,” Dahan said.
According to Dahan, this popularity has fueled medical advancements and research.
“There’s new research showing how Botox can even help nerve pain in the face,” Dahan said. “So not only the muscles, but even the nerves that are deeper inside.”
However, he said social stigma surrounding cosmetic Botox can deter patients.
“Some people are afraid of how it’s going to move their face, and that’s because of what they’ve seen with cosmetic Botox on TV or social media,” Dahan said. “We’re not injecting in the sites that move your face, so nothing about smiling, moving your eyes or facial expressions will be different.”
History of botulinum toxin
Dirk Dressler, head of Hannover Medical School’s neurology department and an expert in the medical uses of botulinum toxin, is a pioneer of therapeutic Botox in Germany. Dressler studied and worked closely with Alan Scott, the “father of Botox,” who is credited with developing Botox for medical use.
For years, he said botulinum toxin was viewed as a dangerous and deadly substance.
“There was a single person who came up with this really strange idea to use this substance for therapeutic purposes,” Dressler said. “[Scott] opened a whole field of applications. There has never been before a change in the perception of any substance as dramatic as this one.”
As they began using the toxin to treat patients with eye impairments, various medical and cosmetic applications arose worldwide. However, the path to using Botox for pain disorders was anything but straightforward.
“It was very experimental,” Dressler said. “It was not concept-driven or anything. Why not just try it? We tried severe cases and we found out that it worked.”
Unlike other drugs developed by sizable pharmaceutical companies, Botox “was 99 per cent developed by the doctors treating patients, individual patients, trial and error,” Dressler said.
While Botox’s medical benefits are now well-established, misconceptions about the treatment linger. Dressler said just the word “toxin” can be a significant deterrent, emphasizing the importance of increased research and understanding of the drug.
“I know very few drugs that have a better safety profile than botulinum toxin,” Dressler said.
Not for everyone
While Cross had a “life-changing” experience with Botox, not everyone has found success. Louis Legault began living with chronic migraines 15 years ago.
“At the beginning, I would have to call off work and cancel on plans. It really affected me in that way,” Legault said.
After her neurologist suggested Botox, Legault was ready to give it a try.
“I took the Botox for a good five years, and it never really helped,” she said. “The actual areas with the needles were very sore, and I would have [the treatment] every two and a half months.”
Only 50 per cent of people see improvement in their migraines after one or two Botox sessions, according to the U.K.’s National Migraine Center.
“It’s worth trying because for some people it works, others it doesn’t, but if it doesn’t work within three or four treatments I would stop and try something else,” Legault said.
As more people turn to Botox for relief, the conversation around its therapeutic potential continues to evolve. While it’s not a cure-all, it offers a new solution for patients like Cross.
“I’ve taken zero medication in between, I haven’t even had to take an Advil for a headache,” Cross said.
Featured image provided by Andrew Cross.
