Friday, October 19, 2012


Botox Therapy for Chronic Migraine

What is migraine?
  • Migraine is a condition, characterized by repeated episodes of headache.
  • Headache can be on one side or both sides of head.
  • Headache typically lasts for more than four hours, but usually resolves in less than 72 hours.
  • Nausea (a sensation to vomit) or vomiting may be present during headache episodes.
  • There may be photophobia (headache becomes more in bright light or sunlight) or phonophobia (headache becomes more in noise).
 What is chronic migraine?
A person, who has been suffering from migraine, for a period of more than six months, is said to be suffering from chronic migraine.

What is the impact of chronic migraine on the sufferer?
Chronic migraine leads to a number of problems in the sufferer:
  • Recurrent headache interferes with job or studies, leading to poor performance at work or in studies.
  • It leads to frequent absenteeism at workplace or in college.
  • People suffering from chronic migraine can not enjoy social functions, as slight triggers such as music can trigger the headaches.
  • They need to avoid road travel, as it can trigger headaches.
  • Patients are frequently forced to take multiple analgesics (pain-killers) every month, leading to significant adverse effects.
What are the treatment options for patients with chronic migraine?
Patients with chronic migraine, who get three or more than three episodes of headache in a month, require preventive therapy (medications to prevent repeated episodes of headache).

What are the commonly used medications to prevent headaches in a migraine patient?
Following medicines (with their brand names) are available for use in chronic migraine:
·        Amitryptiline (Tryptomer)
·        Flunarizine (Sibelium)
·        Propranolol (Betacap TR, Ciplar LA)
·        Divalproex (Divaa OD, Dicorate ER)
·        Topiramate (Topamac)
·        Botulinum toxin (Botox) injections

What are the disadvantages of oral medications?
1.      Lack of efficacy- many people do not adequately respond to these medications. They continue to get recurrent headaches despite taking them for long periods.
2.      Adverse effects- Significant adverse effects are noted with oral medications.
·        Amitryptiline- drowsiness
·        Flunarizine- drowsiness, weight gain
·        Propranolol- aggravation of asthma, depression
·        Divalproex- weight gain, tremors of hands, hair loss, pregnancy-related complications,
·        Topiramate- tingling of feet, weight loss, glaucoma in rare cases, renal stones in rare cases.
 3.      Need to take them on a daily basis

What are the advantages of Botox injections over oral medications in migraine treatment?
1.      Efficacy of botox in migraine has been proven in research and clinical practice.
2.      Botox is fairly safe and the side effects are negligible.
3.      Botox injections need to be repeated once in 3-6 months, so, the patient compliance is better and they can get rid of daily tablets.

Facts regarding Botox injections in a patient with migraine
·        There are fixed points over the scalp, where the injections are given (irrespective of the site of head pain).
·        These locations include front of head, over eyebrows, temple region, back of head and neck muscles.
·        Injections are given by a neurologist, who is trained in the botox procedure.
·        It is given by insulin syringe and needle, and is given in the superficial tissues (scalp muscles, which are hardly a few mm beneath the skin).
·        Topical (surface anesthetic) creams are used, so, the injection does not hurt much and is almost painless.
·        The whole procedure can be completed in an office (Outpatient) set up and is completed in 15-20 minutes.
·        Patient can leave for office or home immediately after the botox procedure.
·        A total dose of 155 units of botox is used in chronic migraine.
Are there any side effects of botox injections?
·        This is the same botox that is used in cosmetic procedures and several million patients have received botox for neurological problems as well (such as writer’s cramp, dystonia, blepharospasm, post-stroke spasticity, hyperhidrosis, etc).
·        It is among the safest injections, and has no serious side effects.
·        Mild pain at the injection site may be felt (just as is felt with any injections).
·        Mild bruising (and redness) and swelling may occur at the injection site.
·        Mild eyelid droop may occur, which improves in a few days on its own.

My experience with Botox in migraine
  • I see about 15-20 new cases of migraine per month, and have seen thousands of patients in the past 18 years of my medical practice.
  • About 20-30% of them either do not improve with oral preventive tablets or they have side effects with them. Some people find it difficult to take tablets on a daily basis for a long period of time.
  • For this group of patients, botox injection therapy is the most ideal. I see 2-3 patients per month, who are eligible to receive botox therapy in chronic migraine. About 1-2 per month receive them. In the past two years, I have given botox to about 40 patients with chronic migraine.
  • About 95% patients report benefit after botox therapy and in most cases, oral tablets are not required after botox.
  • None of them reported any adverse or side effects with botox.
I would like to share an interesting experience with one of the patients. Mrs Nazia (name changed) from Dubai came in June 2012 for botox therapy in migraine. I gave her the injections on OP basis on the usual sites, including forehead. She had no side effects with botox. She came back for review three months later and reported that she was totally headache-free. However, she wanted a repeat botox injection. I was surprised. I asked her if she has no headache, then why does she want botox! She said, after botox, her husband has started to give her more attention and love, as her face has also improved (then, I realized that she wanted it for cosmetic effects). She also told me that three of her colleagues at her office want the botox to be given by me (but only for cosmetic reasons). I had a tough time, referring them to a cosmetic surgeon for the same.

If you want any further information regarding botox therapy in migraine, please email me at

Dr Sudhir Kumar MD (Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Jubilee Hills, Hyderabad


Anonymous said...

Very useful blog. Keep up the good work.

Dr. Sudhir Kumar said...

Thank you for your appreciation.

Anonymous said...

Hello. And Bye.

Jeny said...

Thanks for great sharing regarding Botox Cosmetic Treatments .

Anonymous said...

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Satyem said...

Hi Sudhir,
it is really informative post. I have one question related to my father's illness and I hope you might advice me to go in right direction. From past year my father is suffering from blackouts/fainting problem. He gets a sudden attack and faints for 2-3 minutes and then become normal. It happened three times over last year. Every time we took him to doctors and they could not find any things in the tests. They could not find anything in the MRI scans as well. We almost saw every good neurologist in Kanpur. Could you please help me state which hospital could we go in delhi NCR region or any other advice.


Dr. Sudhir Kumar said...

Hi Satyendra,

Thank you very much for your appreciation.

For your father's illness, in Delhi, You can consult Dr Vinit Suri (Apollo Hospitals, new Delhi) or Dr Rajshekher Reddi (Max Hospitals, Saket).

Best wishes,
Dr Sudhir Kumar
Neurologist, Hyderabad

jindi said...

thank u so much for sharing such a useful info with us nice..........

botox for wrinkles in India

arun kumar said...

sumatriptan is a popular FDA recommended derugs which treats the long term migraine problems,which combination that relieves migraines in adults also works well in child.It triggers brain chemical to reduce frequency.

It's My Life said...

hi sir,
I hail from Hyderabad.just wanted to know how to confirm a migraine..I am suffering from chronic headache which comes almost for every reason.playing hard under sun, insufficient sleep and it persists. It locates on top of the skull and sometimes near the eyes and temple region..plz help.
tnx in advance.

greaterHyderabad said...

Hi sir.

I am SRINIVAS and working in Chennai. My wife is suffering with sever head ace almost daily from mild to sever sInce 3 years. EarlIer It was occassIonal now It became on daIly bacIs. Took all kind of scans. Docs said it's migrant and you have to bare. I am not able to see her suffering like that. I have gone through your blog. She has only right side headache, vomiting, neck and eye pain.

I am seeing your help for a good Neuro physicians in Chennai.

However I hails from malkajigiri.

Please help us.


Botox Treatment said...

Really loved to read the post, actually one of my friend was asking about this Boxtox treatment but at that time I didnt know the meaning, but after reading your post really got good information....thanks for sharing such a beautiful and valuable post which can help a lot. Keep doing....Hope for the new updates....

Farida Parvin said...

Very useful information to overcome headache and it is preferred as the botox treatment cost is more reasonable.

Abdul Massi said...

Dear Thnks for the Information .. Can u Please help in me in migraine problem cause i suffer daily from headache

Anonymous said...

thanks for information can u help me cause i suffer daily from headache

Anonymous said...

sir am getting headache more am gng to so many hosiptals but not cured .plz help me my age is 22 years,my mail

Dr. Sudhir Kumar said...

Hi Bhagyaraj,

It is possible to treat your headache once a proper diagnosis is made. If possible, please consult me once.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Rakhi said...

Dear Dr Kumar, I've suffered from severe migraine headaches for the last 15 years. I'm excited to read about how botox can help. How long term is the treatment? Will injections have to be repeated often? If I go in for treatment what is the range of cost? Kindly do also let me know if there is any neurologist in Mumbai who is experienced in this? Do you visit Mumbai for procedures? Warm rgds, Rakhi Pande. (

Nisha Sharma said...

yes, i had it done around my eyes. it's really not very painful and it's over so quickly.
Nisha Sharma

lilyedwards said...

Such an informative post it inspired me alot i was actually looking for Migraine Treatment Migraine Treatment in Hampshire

lilyedwards said...

It is really a informative post,last month my friend told me about his migrane problem and i read ur post how botox can help.what is the range of cost for Migraine Treatment in Hampshire

Dr. Sudhir Kumar said...

Botox treatment in India (for migraine) cost about Rs 45,000 (1 USD= Rs 67)

Dr. Sudhir Kumar said...

Rakhi, Botox for migraine is safe and effective. It may need to be repeated once in 3-6 months

lata purohit said...

Where can i get good doctor in mumbai who can treat my migraine with botox effectively??

lata purohit said...

I hope my quary is published

Dr. Sudhir Kumar said...

Lata Purohit, you can consult Dr Ravi Shankar K who is a well known headache specialist in Mumbai.

If you find difficult, you can come to Hyderabad for a day and we can complete the botox injection. said...

Sir I'm from Hubli,Karnataka and suffering from migraine from past 6-7 years. Didn't know it was migraine until a family doctor told me 5 years back and since 5 years I'm continuously taking tablets and have consulted many doctors. Who can treat me with the Botox treatment in and around Hubli ?
Is there any permanent cure for migraine?

Dr. Sudhir Kumar said...

@Saajan, there is no one near Hubli to give the botox for migraine, you may find someone in Bengaluru. However, since it needs expertise and is an expensive treatment, I would advise you to meet an expert neurologist for the injection. If you choose Hyderabad, I am ready to treat you (can be completed in one day).

Scarlet VIkram said...


This is Vikram from chennai .I am desperately looking out for BOTOX treatment for Migraine in chennai. Would like to check with you about your availability in chennai in any future dates or any doctor in chennai whom you could refer for treating Migraine with Botox injections. I am suffering with this Migraine headache right from my childhood.

Dr. Sudhir Kumar said...

Scarlet Vikram, you can consult Dr Meenakshi Sundaram Neurologist at Apollo Hospitals Chennai.

manish jain said...

Hello Doctor,

I am suffering from ADEM due to spinal cord infection from six months, when I diagnosed for first time have been given with steroids for 5 days. Later I have been given with 2 doses of Rituximab, Will it be effective to take IVIG after 6 months for me to get my hips and legs movement. I have sensation but no movement. Can you please suggest. Thanks in Advance!!

Dr. Sudhir Kumar said...

ADEM is a monophasic illness, and long term treatment with medicines are not needed. However, complete information can be given only after examination and seeing all the reports.