Sometimes there’s a Happy Hour school parent meeting you want to go to on a Wednesday evening… you already have a low level migraine, but a cherry limeade cocktail🍹 with other parents sounds wonderful. You know this will make your migraine better for a moment and then worse later. Although sometimes it won’t.🤷🏻‍♀️ It’s a toss up and it’s worth it because community and friends are worth hurting for.😍 You have a wonderful time, meet new friends, connect with others.

Pretty drink: Tito’s vodka mixed with Sprite and cherry. Normally, high-end hard alcohol will not trigger migraines for me. But if I already HAVE a migraine, it is not recommended.

Although you’re invited by a small group “to keep the fun going” and have dinner at a nearby restaurant, you sadly know you must decline. You’ve not taken your sunglasses or hat off for the entire meeting. And you know you’ll already be paying a price for the 60 minutes of friendship you’ve just enjoyed. Chronic Migraine demands a high price. Always.💰

So you go home. And you take your medicine like a good patient.🌟

The next morning is bad. Higher level migraine. You’re up for just a few minutes to kiss your daughter🙎🏼‍♀️ goodbye as she leaves for school🏫, make coffee☕ and feed the dogs.🐕 You cannot remain on your feet with eyes open – the migraine is too much. You take your medicine 💊 and encase your head in ice 🧊 and climb back into bed, hurting.

A few hours later, you wake with a start: SURPRISE – you’ve slept for 4+ hours, your migraine is lower, but still present, and you have your ESSENTIAL Botox for Chronic Migraine appointment in one hour! It’s a half hour away. You can make it, but it will be casual doctor appointment dress day🙂

#WaitingRoomShoePic in the car! Covid protocols

The appointment takes only 15 min and nearly painless despite 40+ injections in shoulders, neck, occipitals, temproals, forehead & jaw.💉 It’s pleasant seeing your neurologist this day. Even though last time (12 weeks ago) she was cranky & made you super sad😢. Covid precautions in place at the office, you’re screened before entering exam room and there are only 2 employees in the building (including your neuro) so there’s no waiting. The botox “wheels” have even started to disappear 7 minutes after the injections.

Just 7 minutes after procedure. Some botox injection “wheels” are visible with blue asterisk. Red arrows display the reddened area of my forehead which is not related to botox, but instead is a symptom of my migraine.

This is a sacred appointment… you never miss the day and have been in botox therapy for #ChronicMigraine for a decade. Your next appointment will be early January and you’ll be required to pay the full 2k since your deductible will be reset for the new year.🥂 You’ve already started saving for that. Today’s appointment is 100% covered.🙂
It’s helpful sitting in the car🚗 a few minutes after your botox treatment to settle your body after the barrage of injections💉💉💉💉💉, collect your thoughts and physical well being, and even document your story.✍

You’ll drive home now. Get more ice❄ for both your forehead and back of neck occipitals, rest in your bed🛏 with your head elevated, and maybe even sleep.😴

Basically the day will be done, even though it wasn’t much of “a day” at all. But you did “a thing” and now you can not do anymore “things.”😔

This is one migraine story. One story. Just a glimpse of one – not the entire story. With migraines almost every day, it hardly seems believable that you have about 18 of these stories a month🗓. Many people won’t understand what you’re talking about when you mention Chronic Migraine – they will find it nearly impossible to believe it can happen so frequently (because they had a migraine and they were incapacitated). There will be people who tell you they are “in awe of your strength.” And you’ll be grateful, so grateful, for their kindness and support. But you won’t feel worthy of their praise. You won’t feel strong or inspiring. You’ll feel tired, so so so tired. And you’ll feel so sad that you physically cannot do what you want to do, or what you used to be able to do. You’ll feel so frustrated that you let people down, can’t care for your family like you want to, sometimes can no longer work your career. You’ll battle depression and so much anxiety, because you will never know when the migraine will finally end, and you will have no idea when the next will strike. You will lose the ability to be reliable – you will need to cancel events you really want to attend. Other events you can not miss – you’ll need days and weeks to physically prepare for them. You’ll have a love/hate relationship with medication – because it sucks, but you’ll need to carry it with you at all times. You’ll spend countless hours in a dark room alone and isolated.

And this – this is the story of one migraine.

Covid precautions are not stopping botox treatments AT THIS TIME in Austin, thank goodness!

* * * * * *

Botox for migraine has been FDA approved since 2010 for Chronic Migraine, which is defined as 15 or more migraines a month for at least 3 months. Insurance will want to see you’ve tried cheaper preventatives before approving botox (anti seizure medication like Topamax, cardiac medication like Propanolol, anti depression medication like Amitriptyline) In my humble opinion, it is THE most effective preventative migraine treatment to date. It is administered every 12 weeks. It is a cumulative treatment, so the more you get it, the better the results. Migraine sufferers have varying results, but insurance providers prefer at least a 40% improvement to continue paying for treatment. After some insurance finagaling, your insurance approval will allow for 3 consecutive treatments before reevaluating. It is important to allow yourself those three treatments. Botox is rarely a “magical juice.”

For me, it makes my migraines more responsive to medication, it decreases the severity and duration of my migraines. It does not change the frequency. I still migraine almost every day. Botox injections are normally pretty painless. Although that may be dependent on the syringes used and the administrator’s experience. Most injections are painless, some uncomfortable and some as painful as a slight bee sting. Some injections close to your ear, you’ll be able to hear a “crunching” noise as the tiny needle breaks the skin. Botox is injected juuuuust under the layer of skin – very shallow. It targets the muscles exacerbated in migraine. Because it is injected directly into the muscles, it is unlike most migraine preventatives that are taken orally or systemically and require metabolism in the stomach, liver, etc. For this reason, there are very very few negative side effects to botox. In ten years, I have had one small bruise and one left eye droop, both resolved in weeks.

It is important to take note your anxiety with botox. If it’s your first time, you may be very nervous and it may be helpful to bring relaxing music for earbuds. Also, icing the areas on your head (both before and after) will help with any pain from injections you may experience. Remember that even if the experience is not painful, your body has been assaulted with many tiny needles and you may experience a systemic body response. I used to go straight to work after injections, but now, I feel I have to rest. It often triggers a feeling of malaise and/or migraine, which resolves in about a day.

It’s important to remember not to apply pressure to the injection sites for approximately 12 hours post procedure and plan on some rest post procedure as well. Use ice for any irritation. Elevation of your head also helps the botox absorb effectively.

The general botox for migraine “map:”

After years of working with my neurologist, we have come up with a “personal botox map” specific to my needs.

I strongly recommend every Chronic Migraineur at least try botox as a preventative with a certified botox for migraine provider, if it’srecommended. It is worth the try! And it is nothing to be afraid of.😊

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