As you probably know, the only treatment approved by the FDA for the treatment (preventive) of chronic migraine is Botox (onabotulinumtoxinA). The protocol for injecting it for chronic migraine differs from protocols for other purposes and includes 31 injection sites. You can see the location of those sites in _ this diagram_.
Some migraineurs have told me they’re hesitant to try Botox because they fear needles or because they’re concerned about the injections being painful. Some who are getting Botox treatments dread them because the injections are painful for them. Whether the injections are painful varies from one person to the next. For some reason, it can also vary from one treatment to the next.
I’ve been getting Botox treatments for nearly two years now, and consider the 10 minutes of intermittent pain from the injections to be preferable to having a migraine. I’ll admit, however, that some of the injections have brought tears to my eyes and say not very nice things to my migraine specialist, Dr. David Watson. (He says he doesn’t care what I say during the injections as long as I don’t kick him.) Most of them don’t bother me much, but those across the forehead are difficult for me.
During my Botox treatment last month, Dr. Watson and I tried something new. I’d recently discovered the Chillee Cooling Wand, the purple device in the photo, and was quite pleased with the effect when I used it on painful spots during migraine attacks. Putting that together with the fact that cold can be somewhat numbing, I asked Dr. Watson if cooling an injection site would have any negative effects on the Botox. He said that it wouldn’t and to go ahead and try it.
While he was doing the injections in my shoulder, neck, and head, I moved the Chillee around on my forehead, being sure to cool the areas where he’d be injecting the Botox. To my delight, it worked! I still felt the injections, but they were far more tolerable than they had been during previous treatments. After the injections, Dr. Watson suggested that I bring the Chillee with me every time I come to his office for a Botox treatment.
Another minor issue I’d had with Botox treatments was that some of the injection sites would be sore for a few days. It takes us a couple of hours to drive home from the West Virginia University Headache Center where Dr. Watson practices. So while my husband drove, I applied the Chillee to the various injection areas on and off during the trip home. The results? This was the first time that I had no sore areas after the treatment.
I can’t tell you to do this because I’m not a medical professional, but I did want to share this experience with you. If you’re receiving Botox treatment and have issues with pain at some of the injection sites, it’s worth asking your doctor about using a device like the Chillee, an ice bag, or a cold pack to cool the problem areas. Yes, I do think tolerating the pain and discomfort of the injections for the short time the treatment takes pales in comparison to the pain and discomfort of a migraine attack is manageable. On the other hand, why should anything hurt more than it needs to?
If you try this during a Botox treatment, I hope you’ll come back and post a comment below to share your experience with us!
Make a difference… _Donate to the 36 Million Migraine Campaign! _
_Reviewed by David Watson, MD. _
© Teri Robert, 2014, - Last updated August 1, 2014.
Teri Robert is a leading patient educator and advocate and the author of Living Well with Migraine Disease and Headaches. A co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association, she received the National Headache Foundation’s Patient Partners Award and a Distinguished Service Award from the American Headache Society. Teri can be found on her website, and blog, Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.