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My First Experience With Botox for Migraines

Thinking of asking about Botox to treat migraines? Has your doctor discussed it with you and you are looking for a little more info?

Hello, my name is Adam (Hi Adam) and I have a fear of needles. I have passed out while giving a blood sample type fear. Just the idea of something in my vein… My brain can’t comprehend it as anything but very bad.

So with that in mind I’d like to explain, and slightly exaggerate, how getting 31 injections in my face, head and neck have drastically changed this man’s life. Yep, a male with migraine who gets Botox. Statistically both feminine, I think in most men’s eyes, but that’s for another time.

Follow me, and my brain’s panicked interpretation of my injections. (It ends very well I promise.)

After many years of failed migraine treatments with many different medications, dozens of doctors and countless horrible side effects, my doctor recommended a pain management facility. My first thought is that pain management equals pill mill. I wasn’t excited to be pushed off to a pill mill to say the least.

My first visit to the doctor went much different than I expected. The doctor came in, introduced himself and first explained that I will not be receiving pain medication (opioids) from him and if that is the reason I was there that I could leave. Instantly relieved. We discussed previous treatments and he asked if I would be interested in Botox.

Now, let me explain that after 20-plus years of feeling like a guinea pig for migraine meds I was not thrilled about the idea of Botox but what did I have to lose?

Date of first treatment rolls around. I was really worried walking into the office. Probably shaking, definitely sweating and not just because it’s Florida. The nurse wheeled in a cart with small vials (Botox), cotton in a container of liquid (alcohol) and the syringes. I avoided eye contact with the syringes by staring at the wall when the nurse left the room.

More sweat.

Doctor comes in, and I sign a consent form and a brief explanation of the procedure. He swabs all injection areas with alcohol soaked cotton.

He says, “It take less than 10 minutes, if you need a break just tell me, OK?”

“OK,” I say and close my eyes.

This is the point my knuckles went white on the arms of the chair and of course more sweat.

He starts in between the eyebrows. BAM. Dead center above the bridge of my nose. I try not to jerk my head back but flinching to a needle between the eyes is involuntary. But here’s what nobody told me! It crunches.

Let me interrupt here for just a moment. I will only briefly mention this “crunch” because nobody told me. So my brain is in full panic: “Something is wrong! Is he doing something wrong? Did he just carve into my skull?” I don’t like needles. Anyway, it’s normal. Sorry to interrupt, carry on.

The injection crunches. Not in your ears. You can feel the sound of crunch if that makes sense. It is an in-your-skull sound. Like you can hear each cell tearing from each other. Think of trying to crumble a piece of paper quietly and slowly, that’s about the only way I can describe the sound.

I have sweat running down my back at this point. I just focus on breathing. In and out. Slowly and steadily. My eyes at this point were squeezed so tightly shut the nurse and doctor were probably trying not to laugh. I couldn’t hear them over the crunching though. Did I mention the crunch? (It’s really not “loud” really but mentally it’s all my brain could hear.)

The doctor continues on one side of the brow, then the other, working from that first center injection out toward the temples. Each injection is a shallow, slow prick followed by a slight pressure around the injection site. All of them crunched, in case you were wondering. Several injections around each temple. These are the most painful injections for me personally.

My migraines manifest in a way that it feels someone is taking a knife and pushing it through my temple into the back of my eye. Not sure if that’s why the temple injections hurt so much more than the others but they suck. I usually find myself holding my breath through those injections and let out a small gasp when he moves on.

Next is above the ear, working around to the back of my head/neck, alternating sides for each area. Thankfully the crunching stops somewhere around the temples. A couple on either side of the back of my neck down to the collar of my shirt.

Side note: I haven’t had neck weakness but before he starts neck injections he always asks if I had any issues with neck weakness so I assume that he could adjust the injections if that was a problem, but not the first time obviously.

At this point I open my eyes and can feel the tension releasing from having it scrunched for 10 minutes. The nurse dabs at injection sites that may still be bleeding/seeping slightly. Doctor takes his gloves off and asks if I have any questions or need any prescription refills and off he goes. The nurse explains I should try to keep my head upright for several hours and don’t rub the injection sites.

I walk out feeling like I have fire ants latched onto my face, adrenaline still pumping from the trauma of injections in my face. I go home exhausted. It’s only around 9 a.m., but I can’t lay down or I’ll look like a stroke victim I’m told. I have not tested that and don’t plan on it.

A migraine starts about five hours after I get home, every time. Never a raging migraine but I want nothing more than to lay down in a dark quiet room and put an ice pack on my head kind of migraine. Next day my brow is tender, NSAIDs take the edge off this pain. Each day afterward the pain is less and less, usually for about three days.

Two weeks go by and migraines have been steady but slightly less intense, but only noticed when I checked my migraine tracking app. Three weeks go by and I have a migraine-free day followed by a pain-free day. At this point I’m nervous thinking the migraine is just regrouping and going to jump on my face all rested up and ready for a fight.

A week migraine free.

16 days.

This is how the rest of the world lives? Wow. Must be nice, I’m thinking.

During a follow-up appointment I explain the difference and the doctor is thrilled. I even printed my migraine tracking results as proof. He tells me I am lucky enough to be in the something like 10% who have positive result following the first treatment.

Leading up to my next treatment the migraines began coming back, about two weeks before. Less intense and less frequently than before treatments but if I want insurance to pay for the treatment I have to follow a schedule they approve.

The second injections were much easier because I knew what to expect. Crunch. Three years later and I joke that I look forward to 31 injections in my face.

Everyone is different. We all live with this horrible condition in our own way. We all feel different and tolerate different. This is just my experience with Botox. After 20-plus years of failed treatments I have found one that works for me. It is not perfect. My last treatment was delayed two weeks due to COVID-19 and I do not expect to be anywhere near my record 24 days migraine-free until after the next set of on time injections.

I now take half a triptan after my injections to fight off the imminent migraine after each treatment. I have attempted counting the injections during the treatment but to this day the farthest I’ve made it is five, maybe six. I don’t know what happens but afterward I can’t remember why I stopped counting. I guess fight-or-flight has no time for counting.

I still fill my triptans religiously but now have a small stock pile where as before I would run out halfway through the month.

Hopefully my story enlightens you on what to expect or maybe just some entertainment. It is well worth the outcome for me, I now look forward to them. Best of luck. I can’t say Botox will work but I would recommend giving it a try even with, what I feel is, a healthy fear of needles.

I still hate needles.

Photo by Alek Kalinowski on Unsplash