Botox has an image problem. Despite media scare stories, Botox has become one of the most popular anti-aging treatments today, but somehow it's still kept as a closely guarded secret by many ageless celebrities. This snobbery has dented its medical credibility.

But at last Botox has reinvented itself as the most effective treatment for chronic migraines. What an incredible reinvention.

What's the Difference Between a Headache and a Migraine?

Most of us have experienced a headache at some point in our life, but migraines only affect a minimal amount of people. The intense nausea and throbbing is far more debilitating than an annoying headache and can really damage the sufferer's quality of life. Those who are sensitive to light, smells and noise may also experience an aura (a visual distortion) and slurred speech.

There Isn't a Cure Because Scientist Aren't Sure What Causes Migraines

Certain triggers (either mental, physical or emotional) seem to reduce levels of the brain chemical serotonin. This reduction could cause blood vessels in the brain to spasm then dilate, pressing on certain nerves, which then send pain signals to the headache site.

Migraine sufferers also seem to be extra sensitive to triggers, such as certain foods, stress, muscular tension (we all tend to hold tension in our shoulders), tiredness or sensory overload from strong flavours, bright lights or loud noises. The vast majority of sufferers are women, so female hormones are a major trigger and there's often a genetic connection.

The History of Botox

Botox Type A is a purified nerve toxin or poison derived from a bacteria which causes muscle paralysis. No wonder it has an image problem. But it has been used medically for decades and has an excellent safety record. For example, it has been used to treat children with squints since the 1970s.

In the mid 1990s Botox started to be used cosmetically to soften expression lines. By sheer coincidence, patients noticed an improvement in their migraines as well as their wrinkles! This prompted years of research and, in 2010, Botox was finally approved by the FDA to treat adults with chronic migraines. (Did you know Millennials are getting Botox? Learn why in Botox at 30? Why Millennials Want Injectables Now.)

Botox is Still Considered a Last Resort

Migraine sufferers can build up a tolerance to stronger painkillers, which oddly enough, can trigger headaches. For regular migraines, there are preventative options.

Antidepressants

Increase levels of the brain chemical serotonin.

Beta-blockers

Reduce the release of of pain messages from nerve endings.

Anticonvulsant medications

Suppress activity of brain cells. However, the side effects include weight loss and pins and needles.

Botox is usually a last resort for most sufferers once the above methods have failed – possibly because of cost. To qualify for Botox, the patient needs to experience at least 15 headaches per month, of which eight are migraines.

So How Does Botox Cure the Pain of Migraines?

Cosmetically, Botox blocks the nerves from sending information to the facial muscles, which paralyses them. So if you can't frown, you can't get a frown line. But no one is really sure how Botox blocks the pain signals that lead to a migraine. (There's lots to consider before getting Botox injections, read 7 Key Things to Watch Out for If You Are Considering Botox Injections.)

There are two theories to consider.

First Theory

Botox blocks chemicals called neurotransmitters that carry pain signals from the brain before they get to nerve endings at the headache site. It also possibly blocks sensory overload information from the muscles in the face, scalp and neck which can trigger migraines.

Second Theory

There is another less popular theory. Perhaps it works in the same way as cosmetic Botox and relaxes overactive muscles surrounding the head from pressing on the nerve and triggering a migraine (a muscle spasm).

What Patients Can Expect

The procedure takes about 15 minutes and involves between 30-40 injections around the head, back of the neck, base of skull, forehead, temples and upper shoulders; which is far more compared to aesthetic Botox. You can expect to see results within 2-3 weeks afterwards.

There's no need for local anaesthetic, although expect a certain amount of discomfort due to the sheer number of injections. Sufferers must be patient because they may not see results until the second course.

Cons of Choosing Botox

Botox is slowly metabolized in the body, so injections need to be repeated every three months. (If it's administered more often than the body can develop antibodies). While it seems inconvenient, this does mean that any side effects are temporary, and usually quite mild: headache (ironically), neck pain, eyelid drooping, muscular stiffness, itching, injection site pain, bruising and discoloration.

Because Botox is a toxin, it's important that it doesn't travel to other parts of the body, so make sure you go to an experienced medical doctor rather than an aesthetic practitioner.

Pros of Choosing Botox

Think of Botox as prevention rather than cure. The results are impressive: migraines were less severe and most patients experienced fewer than half their number of days with headaches. Long term, Botox may even lead to a cure by identifying which nerves are responsible for triggering migraines.

Surgical intervention to release pressure on specific nerves would therefore be more accurate. However, it was no better for pain reduction compared to painkillers and has not yet shown to be effective on episodic, tension or cluster headaches.