Answers to 2 common questions about Botox for Migraines: what it is, what it costs, what results to expect and what can go wrong.
"Ocular migraine" usually means migraine with visual aura: shimmering zigzag lights or a blind spot that builds over 5-20 minutes and clears within an hour. It often needs no acute drug: rest in a dim room, then treat any headache that follows. Frequent attacks warrant preventive therapy.
Two different things get called ocular migraine. Visual aura affects the same half of the visual field in both eyes and reflects a wave of cortical activity: it is benign and self-limiting. True retinal migraine causes vision loss in one eye only (cover each eye to check) and needs ophthalmology and neurology evaluation; triptans and ergotamines are generally avoided in it. A first-ever episode of visual disturbance without headache must be evaluated urgently to exclude TIA or stroke. Call 911 for visual symptoms that start suddenly at full intensity, fail to resolve within 60 minutes, or come with face droop, weakness, or speech difficulty. If you have aura, avoid smoking and estrogen-containing contraception: both raise stroke risk. Preventives include magnesium, propranolol, and topiramate.
Abdominal migraine (recurring attacks of midline stomach pain with nausea, vomiting, and pallor, mostly in children) is treated like migraine: rest in a dark, quiet room, ibuprofen or acetaminophen, and antiemetics for acute attacks; propranolol, amitriptyline, or cyproheptadine for prevention. Other causes of abdominal pain must be excluded first.
Abdominal migraine is recognized by the ICHD-3 as a childhood migraine variant. Attacks last 2-72 hours with complete wellness between them, there is usually a strong family history of migraine, and many children go on to develop typical migraine headaches in adolescence. Because it is a diagnosis of exclusion, a pediatrician needs to rule out gastrointestinal, urinary, and surgical causes before it is treated as migraine. All drug treatment here is off-label and extrapolated from migraine care. Lifestyle is unusually powerful in children: regular sleep, regular meals, and hydration often outperform medication; the 2017 CHAMP trial found amitriptyline and topiramate no better than placebo in pediatric migraine. Botox has no role in children. See a pediatrician or pediatric neurologist.
General information from our editorial team, not medical advice. Talk to a licensed provider about your own situation. See our editorial standards.
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