114. What No One Tells You About Botox and Migraines

In this episode, I’m talking about something I’m not hearing many people in the migraine space discuss openly, Botox as a preventative treatment for chronic migraines.

My goal isn’t to scare you or tell you what to do. My goal is to make sure you have the full picture before you make a decision about what goes into your body. I explain what Botox actually is, how it works in your body, why the migraine protocol uses far higher doses than cosmetic Botox, and the long-term concerns I have around muscle atrophy, neck function, CGRP, and your body’s overall toxic load.

I also share why I believe neck pain is often a symptom of migraines rather than the cause, and what I recommend focusing on instead if you want real, long-term healing. If you haven’t yet listened to my previous episode on trigger point injections, I highly recommend pairing these two together, they build on each other and give you a fuller understanding of what’s really driving your chronic migraines.

Check out the podcast episode about trigger point injections:

Trigger Point Injections and Migraines. What Nobody Tells You

If you’re ready to address the root drivers of your migraines, you can book a free consultation at the link below:

https://www.drlesliecisar.com/apply

Free Training: 5 Proven Steps to Being Migraine Free (Even if you think you've already tried everything.)

https://www.drlesliecisar.com/5SHMN

Connect with us:

Website: https://www.drlesliecisar.com/

Free Facebook Group: Healing Migraines Naturally, with Leslie Cisar, ND

Ready to try something radically different that actually works? Read more about my approach here: https://www.drlesliecisar.com/map

In health,
Dr. Leslie Cisar

Episode Transcript

hi there
welcome to the Healing Migraines Naturally podcast
I'm your host Doctor Leslie Caesar
and I'm a licensed naturopathic physician
a former chronic migraine sufferer
and I help women all over the country
rediscover a migraine free life
and today I want to talk about Botox
specifically
Botox as a preventative treatment for chronic migraine
and I want to share some things with you
that I think are really important
things that I'm not hearing anyone else talk about
before I get into it I want to say this
I'm not here to scare you
I'm not here to tell you what to do
what I am here to do is give you information
because you deserve to have this information
before you make a decision
about what goes into your body
and if you caught my last episode
on trigger point injections
you already know that I have some concerns
about injecting substances into muscles
that are already tight and toxic
so today I'm gonna go a step further
because Botox is a very specific kind of injection
and there's a conversation around it
that I think is long overdue
so let's get into it
so first I want to start by acknowledging something
when your neurologist recommended Botox
or when you started reading about it
part of you probably had a reaction
maybe it was subtle maybe it was loud
but there was something that made you pause
and I think a lot of you
if you're really honest thought to yourself
wait I don't have a Botox deficiency
why would I inject a toxin into my head and neck
and that instinct is worth paying attention to
and today I wanna tell you why
so let's start with the basics
what is Botox Botox is botulinum toxin
it's one of the most potent neurotoxins
known to science and I'm not saying that to scare you
I'm saying it because it just is what it is
and I think it's important to call it by its name
botulinum toxin
it was approved by the FDA for chronic migraine
it was approved by the FDA
for chronic migraine prevention
in 2010
now
chronic migraine is defined as 15 or more headache days
per month
so while it is FDA approved
for people who meet that diagnostic criteria
of 15 or more migraine days per month
many times
insurance companies won't cover this treatment
until you have quote unquote
failed other preventative treatments
that is to say you've quote unquote
failed other cheaper preventative treatments
okay so
even though it's FDA approved
for people with 15 or more
days per month sometimes insurance won't cover it
um until you've jumped through a few hoops
so
the way Botox is usually explained to patients is this
it relaxes the muscles in your head and neck
and by doing that it prevents the migraine
that's the story most people are told
and I understand why it's simple
it makes intuitive sense and for a long time
that's actually what doctors believed was happening
but here's the thing
the current science tells a more complicated story
hi there I want to jump in real quick
and tell you about my client Beth
she was getting 15 to 20 migraines and headaches
per month and as you can imagine
this was impacting her work performance
and her confidence she also has two small children
and she was
starting to feel like she was a horrible mom
because she had nothing left for them
at the end of the day but she reached out
and she booked a free consult call with me
and after I asked her about her migraines
and her health history
I felt confident that I could help her
I help women uncover
the root drivers of their migraines
and follow a step by step plan to dramatically reduce
the frequency by up to 90%
without adding more medication
or taking a bunch of supplements
so we built her personal migraine map
followed the plan
and now she will get one to two migraines per year
which she uses ibuprofen to treat if she needs to
verses up to 15 to 20 per month
when we first started working together
that weren't responding well to any medication
she just reached out to tell me that
she got a promotion at work
she's on top of her career again
and has been able to come off all of her migraine
medication but most importantly
she's a confident mom again
and she's attending birthday parties at Jump Zone
with her kids and saying yes
instead of saying maybe later
I've worked with women like Beth
from all over the United States
who were told this is the best we can do
but they were still willing to dig deeper
so if you're serious about changing your migraine story
go to Doctor Leslie Caesar dot com slash apply
or tap the link in the show notes
and on our free consult
we'll map out why your migraines keep coming back
and the first three steps you can take
over the next 30 days
I do cap new client spots each month
so if the calendar is full
the doors are closed for now
but if you're done feeling helpless
and ready to do the work to heal
pause this episode for 30 seconds
and book that console call
now
what researchers now understand
is that Botox is not working
primarily through your muscles
at all it's working through your sensory nerves
what it's doing is blocking
the release of specific molecules from your
nerve endings molecules called CGRP
substance P and glutamate
these are the molecules that when released
they believe trigger the migraine cascade
so Botox steps in and says
you don't get to release those
now CGRP is going to sound familiar to a lot of you
CGRP calcitonin gene related peptide
this is the same molecule that the newer class of
migraine drugs is targeting your Aimovig
your Nertec your Qulipta
those medications were developed specifically
to block CGRP and now Botox
it turns out is doing something similar
just through a different mechanism
so we have Botox blocking CGRP
we have a whole new class of drugs blocking CGRP
we are putting a tremendous amount of effort
into making sure your body
cannot use this molecule and here is the question
that I want you to sit with today
why is your body generating CGRP in the first place
because here's what I want you to understand
CGRP is not a migraine defect
it is not some random malfunction
that your broken brain is producing
for no reason
CGRP is produced throughout your entire body
not just your trigeminal nerve
which is the nerve system
that conventional medicine focuses on
with migraines CGRP is produced in your gut
it's produced in your peripheral organs
it's found in nerve fibers that innervate virtually
every major organ system in your body
and it's doing critical protective work
specifically CGRP is anti inflammatory
it protects the lining of your gut
it regulates your immune response
it helps with motility
it's an active participant in keeping your gut healthy
and functioning
and here's what the research shows
when scientists blocked CGRP in animal studies
gut inflammation got worse
recovery from colitis was delayed
blocking CGRP did not help
it made the inflammation harder to resolve
because CGRP was there trying to limit tissue damage
in the first place
so let me say this as clearly as I can
your body is not generating CGRP because it's broken
your body is generating
CGRP because something is inflamed
something is wrong in the internal environment
and your body is trying everything it can do
to protect you
CGRP is not the problem
CGRP is the firefighter and what Botox does
what the anti cgrp drugs do is fire the firefighter
while the fire is still burning
you might feel some relief
the alarm gets quieter but the fire
the fire is still there
and until we deal with the fire
the alarms are going to keep going off
the question that I ask
the question that nobody else is asking is
what is your body protecting you from
what is the fire that's where the real answers live
now I wanna share something that I think is gonna
surprise you
and I have not heard anyone else in the migraine space
talking about this when we say
Botox prevents migraines by relaxing muscles
even if that's an oversimplification
as we just discussed
there is still a muscle component to what Botox does
because Botox does prevent muscles from contracting
that's part of its mechanism
that's why right that's why it's injected into the face
to prevent those facial muscles from contracting
and making wrinkles
and I want you to think about what that means
over time
Botox does not directly weaken your muscles
what it does is prevent them from contracting
and muscles that are not contracting
muscles that are not being used will weaken over time
they will atrophy that's not just my opinion
that is basic well established physiology
use it or lose it right
we all know this so
let me put this in perspective
with a number that I think will surprise you
when someone gets Botox for cosmetic reasons
right to
smooth out the forehead lines
crow's feet that kind of thing
a typical treatment uses somewhere between 20 and 50
units total
that's for the whole face
the standard migraine protocol
a minimum of 155 units up to 195 units
that's three to eight times the amount used
for cosmetic purposes
injected into far more sites and critically
into your neck
that protocol is called preempt
155 units of botulinum toxin injected into 31 sites
across seven muscle groups
those muscle groups are the forehead
the area between the brows
the temples the back of the head
and then the neck
specifically
specifically the
specifically the cervical paraspinal muscles
those are the muscles that run alongside your spine
and your neck
and the trapezius
which runs across your upper back and shoulders
so I want you to stop for a moment
and really think about that
your head weighs between 10 and 12 pounds
the muscles in your neck are
responsible for holding that weight up
all day every day
these are not like small incidental muscles
these are structural
load bearing muscles that are doing real
constant mechanical work and if those muscles
are being prevented from contracting fully
four times a year every 12 weeks
year after year
what is happening to them over time
I have not heard a single neurologist ask that question
and I think it deserves to be asked
because the research does support this concern
studies have confirmed that with prolonged Botox use
true muscle atrophy can occur in both the muscle fibers
themselves and in the sensory nerves inside the muscle
that send feedback signals back to the brain
there are published case reports
in the medical literature
of patients developing serious cervical deformity
abnormal curvature of the neck
following Botox injections to the neck muscles
the physicians raising these concerns
tend to be orthopedic doctors
and regenerative medicine specialists
practitioners
who are working with the musculoskeletal consequences
of these injections
they are seeing the downstream effects
and the neurologists who are prescribing Botox
are not always connecting those dots
some of these women have been on Botox for five
eight 10 years
nobody has stopped to ask
what is happening to their neck
I think we need to start asking now
I want to bring in something
that many of you have heard me talk about before
on this podcast because it's directly relevant here
I want you to think about what a hangover feels like
okay you go out on a Friday night
you have a little too much Saturday morning
your head is pounding the light is killing you
every smell is overwhelming
you feel nauseous you can't think straight
your whole body feels terrible
does this sound familiar it should
because it is almost exactly what a migraine feels like
and that is not a coincidence
a hangover is your body in a toxin overload state
your liver is overwhelmed
it is working as hard as it can to process
and clear all of that alcohol
which is a toxin from your system
and until it does you are going to feel terrible
you can take Advil you can eat toast
you can put a cold cloth on your forehead
but you know that you are going to have to wait
until your liver finishes the job
migraines work the same way
your toxin bucket has spilled over
your liver cannot keep up with the load
and the symptoms your body generates when that happens
the head pain the nausea
the sensitivity to light
to noise to smell
are nearly identical to a hangover
because the mechanism is the same
if your toxin bucket is already full
and if you have chronic migraines
I'm telling you
it is the last thing you wanna do is add more to it
and that is exactly what Botox does
Botox is botulinum toxin
it's a toxin and your liver has to process it
and it has to add it to the queue
along with everything else it is already trying to
clear so you might get some temporary relief
because the nerve signal is being blocked
but you have not drained the bucket
you've added to it and until we drain the bucket
the migraines keep coming
and I wanna add one more layer here
and I went into this in a lot more detail
in the Trigger Point episode
so if you haven't listened to that one
please go back and listen
I'll link it in the show notes
but here's the short version
a very common pattern with migraines
is that the pain starts in the neck
and then moves up into the head
and naturally
completely understandably
people assume
that the neck is where the migraine is starting
my neck is the problem I need to treat my neck right
so that would make sense
like inject something here into my neck
put this Botox into my neck
but what I want you to consider is this
your neck pain may actually be a migraine symptom
not the source of your migraine
and here's a simple way to tell
if you take a migraine specific abortive medication
like a triptan
Imitrex or Maxalt
or a CGRP antagonist like Nertec or Ubrelvy
and your neck pain goes away as the migraine
um a tryptin like Imitrex or Maxalt
or a CGRP antagonist like Nertec or Ubrelvy
and your neck pain goes away as the migraine lifts
that's your answer those medications
work specifically on migraine mechanisms
they are not general pain relievers
if they relieve your neck pain
it's because the neck pain is part of the migraine
not because it's the cause of it
so when we look at the standard Botox protocol
31 injection sites including the cervical
paraspinal and the trapezius
we are targeting muscles that are likely expressing
a migraine symptom
we are treating the symptom in the neck
while the actual driver of the migraine
goes completely unaddressed
repeated neurotoxin injections
in load bearing neck muscles
for years targeting a symptom rather than a cause
that is the full picture so what do I do instead
what I do is look at all three of what I call
the three principles
the three things that your body needs
in order to function properly
and maintain its health
every client's picture is unique
and for most people
all three principles are involved to some degree
but that said for many of the women I work with
Principle 2 what I call
an accumulation of metabolic waste materials
or toxins it's a significant driver
the bucket is full the drain is clogged
and the liver doesn't have what it needs to keep up
my job is to figure out why
what is your liver missing
what is blocking it
and then we work on supporting it gently
very carefully at exactly the right pace
for someone who is prone to migraines
and I want to be very clear about this
because I know some of you
have tried detox protocols or cleanses
and they have made you feel terrible
I'm haha I've been right there with you
there is a reason for that
if you have chronic migraines
your bucket is already right at the top
and if you push your liver too hard
you're going to tip that bucket over
and trigger a migraine
I have spent years developing an approach
that is specific to migraine sufferers
one that supports the liver without overwhelming it
we're not pushing we're not forcing
we are gently steadily getting that drain open wider
and when we do the bucket starts to go down
and here is what happens to the CGRP
when that bucket starts to drain
remember your body was generating CGRP
because it was trying to protect you from inflammation
guess what drives inflammation
toxin overload okay
so when we reduce the toxin load
when the liver starts keeping up
then the inflammatory burden goes down
your body has less to protect you from
the CGRP signal quiets down on its own
not because we blocked it
because we addressed what it was responding to
that is the difference we're not firing the firefighter
we're putting out the fire
now if you're already on Botox
I've got some good news okay
I wanna speak directly
to those of you who are already on Botox
and I wanna start by saying this clearly
I'm not judging you not even a little bit
you were in pain you went to your doctor
you did what they recommended
that makes complete sense
and I would never fault you for that
what I want is for you to have more information
than you had before that's all
and here's something that I want you to know
even women who are on Botox as a preventative treatment
they are usually still getting migraines right
it may be helping
it may be reducing the frequency or the severity
someone
it may be reducing the frequency or the severity
somewhat but it is not solving it
most of the clients I work with who are on Botox
when we start working together
are still suffering still missing work
still missing life
and here's something really important
being on Botox does not stop you from doing this work
it does not prevent you from draining the bucket
you can absolutely start addressing the root causes
supporting your liver reducing the toxic load
working on all three principles
while you are still on Botox
those two are not mutually exclusive
in fact this is exactly how most of my clients
who are on Botox approach it
we start the work the body starts to respond
and the Botox becomes less and less necessary
on its own
but here's the good news
as we start to address the causes
as we work on draining that bucket
they start to get fewer and fewer migraines
they start feeling better and better
their good days start to outnumber their bad days
and then more and more good days
and at some point
these women reach a point where they feel good enough
they feel confident enough
and they decide on their own
that they want to talk with their neurologist
about coming off Botox
and here's what I found in my experience
working with clients who've made that decision
Botox is actually one of the easier
preventative treatments to discontinue
when you're feeling better
women who work with their neurologist
to taper off that Botox dosing
and this can look like you know
if you're going in every three months
hmm let me try four months
let me try five months let me try six months
that can be a strategy that they
work out with their neurologist
or frankly a lot of women I work with
they just tell their neurologist
I'm not I'm not coming in I
I feel too good I'm not gonna do it anymore
and what I found is even if people
you know under neurologist
under their neurologist care
completely discontinue the Botox injections
if they're already feeling better
if they've already done what they have needed to do
to restore their body back to health
they do just fine it's really one of the easier
preventative treatments to come off of
so what I want you to know is
if you do the work
to bring your body back into a state of health
that work holds
my clients don't go back to where they started
and that's that's the goal right
not to take something away from you
not to leave you with nothing
the goal is to get you to a place
where your body doesn't need the Botox anymore
because the fire has been dealt with
so let me leave you with this
you already knew something felt off
knew you didn't have a Botox deficiency
that instinct was not wrong
your body is not generating CGRP randomly
it is not creating inflammation for no reason
it is not producing symptoms because it's defective
it's doing all of those things
because it's trying to protect you from something
and the most important question you can ask
the question that changes everything is
what is it protecting me from
that is the question that I ask
that is the question that I have been asking
for nearly 9 years
working exclusively with women with chronic migraines
and I can tell you when we find the answer
things change
if this episode resonated with you
please share it
there are so many women out there right now
who are being offered Botox
who are sitting in their neurologist's office
trying to decide
and they have not heard this side of the conversation
so please share it with them
now the Trigger Point Injections episode is LinkedIn
the show notes
so if you haven't listened to that one yet
I really recommend starting there
it lays a lot of the groundwork
for what we talked about today and if you're
if you're ready
to figure out what is actually driving your migraines
I'd love to talk with you
you can book a free consultation call with me
um the link to do that is in the description
and on that call we will look at your full picture
your migraines your other symptoms
your health history
and I will be honest with you about whether
I think I can help you and what that would look like
I do cap new client spots each month
so if the calendar is open
grab it so thanks so much for being here today
and I will talk to you next time