Therapeutic Botox for Post-Concussion Headaches: A Game-Changing Treatment

Concussions can have devastating and long-lasting effects, with chronic headaches being one of the most debilitating symptoms of post-concussion syndrome (PCS). For many patients, these headaches not only diminish their quality of life but also impact their cognitive function, sleep, mood, and emotional well-being. While traditional treatments like pain relievers, beta-blockers, anti-depressants, and simply waiting it out have been the standard approach, an often-overlooked but highly effective treatment is Botulinum toxin, or Botox Therapeutic.

The Science Behind Botox for Post-Concussion Headaches

Dr. Ray discusses therapeutic Botox for migraines with a patient. See Patient Stories for more info.

There is good clinical evidence that treatment with Botox leads to a reduction of monthly headache days and improves quality of life when used as a treatment for chronic migraines, as numerous peer-reviewed studies and clinical trials have presented, including this one from 2016. In 2011, Health Canada approved a protocol for this usage, and Migraine Canada cites it as a viable option for chronic migraine prevention. However, despite mounting clinical evidence, there is no approved protocol specifically for post-concussion headaches. Unfortunately this lack of approval is not due to inefficacy, but rather because it’s up to the drug companies to seek Health Canada protocol approval for new indications, which is a very expensive and lengthy process.

A 2020 study published in Clinical Neurology and Neurosurgery found that Botox significantly reduced headache frequency and intensity in patients suffering from post-traumatic headaches, particularly those with a history of concussion. Despite this evidence, many physicians and insurance companies remain bound to migraine treatment protocols, limiting access to an option that could be life-changing for concussion sufferers.

A Physician’s Perspective: Tailoring Treatment for Individual Needs

Dr. Martin Ray has nearly 40 years of experience managing concussions. With credentials including a Diploma Sport Medicine (Dip. Sport Med.), MCFP (SEM), and CCFP Certificate Sport and Exercise Medicine, he is an expert in sports medicine as well as aesthetics, and has witnessed firsthand the profound impact of Botox therapy on post-concussion patients. Having served for many years as the physician for the Canadian Alpine Ski team, the WHL’s Vancouver Giants, and a number of other national and high-level teams, he has treated countless athletes whose careers and lives have been derailed by head injuries.

“I’ve seen wonderful, talented athletes have their lives stripped from them. Single or repeated head injuries have not only left some unable to continue in their sport, but have, even worse, left them with long-term cognitive issues and in many cases chronic headaches, preventing them and their families from enjoying a normal life,” Dr. Ray explains. “For 20 years, I’ve been treating patients with post-concussion headaches using therapeutic Botox with great success. It improves headaches and cognition in the large majority of patients and, in some cases, clears headaches and brings cognitive abilities back to baseline. These are life-changing treatments.”

One of the biggest challenges, however, is the rigid adherence to standardized protocols, which, according to Dr. Ray, sometimes decreases treatment efficacy. Neurologists, often trained to follow strict guidelines, may hesitate to modify dosages and injection frequency to better suit individual patients. “Protocols can be both a friend and a foe,” says Dr. Ray. “While they provide a framework, they also limit a physician’s willingness to adapt treatment to the patient’s needs.”

Using clinical judgement to adapt dosing gave this patient the best result, enabling her to discontinue medications with negative side effects and reclaim a happy, pain-free life.

He notes that experienced physicians should use clinical judgement to give people the best, safest results, because no two patients are the same. Many patients require higher or more frequent doses than what is typically prescribed for migraines. The PREEMPT clinical migraine protocol is 150 or 180 units of Botox every three months.

“30% of my patients need a larger and/or more frequent dosage to obtain optimal results,” he says. It’s crucial to monitor their response through headache diaries and log medication use to determine how they’re responding. Many headache specialists start with medications before moving toward Botox due to insurance companies’ requirements. In order to find successful outcomes, I prescribe a dosage of up to 260 units and the frequency to every two and a half months, safely obtaining optimal outcomes. ”

Clinical studies, such as specific examples in this ten-year analysis on the effectiveness of Botox for treating chronic migraines, published in 2022, support this. The goal is always to get the patient as close as possible to a normal life with minimal medication or negative side effects.

Why Botox? A More Effective, Safer Alternative

Many conventional medications prescribed for post-concussion headaches come with significant drawbacks. Beta-blockers can cause fatigue, SSRIs and other anti-depressants may have mood-related side effects. Frequent use of analgesics like Tylenol, Advil, narcotics and triptans can lead to chronic medication syndrome. More recently, anti-CGRP medications have emerged as an option, but their efficacy can be variable, and they are expensive.

“Botox, on the other hand, has a much higher success rate — around 95% of the patients I treat see an incredible improvement in their condition — and comes with minimal side effects when administered correctly,” says Dr. Ray. “Some potential downsides include temporary brow heaviness, weakening of your frontalis muscle, or neck pain, but these can be avoided by adapting a modified injection technique.”

An additional, lesser-known benefit of Botox is its potential impact on mood. Many post-concussion patients experience depression. Botox appears to improve sleep quality in addition to reducing headache severity and frequency, reducing the need for multiple medications and improving overall mental wellbeing.

The Barriers to Access: Insurance and Awareness

Despite its effectiveness, therapeutic Botox for post-concussion headaches is not widely accessible. In British Columbia, PharmaCare does not cover the treatment, though some private insurance plans may cover part or all of the cost. Unfortunately, many patients remain unaware of this treatment option, suffering needlessly due to lack of information.

“There’s still a large number of people struggling with post-concussion headaches and cognitive disability who don’t know that Botox could help them,” says Dr. Ray. “As someone who went into medicine to make a difference in people’s lives, treating conditions like post-concussion syndrome with therapeutic Botox continues to be one of the most rewarding aspects of my practice.”

Moving Forward: A Call for Greater Flexibility in Treatment

The success of Botox in treating post-concussion headaches highlights the need for greater flexibility in medical practice. Physicians must have the ability to tailor treatment plans based on patient response rather than being confined by rigid protocols. Similarly, insurance providers must consider physician-determined dosing rather than defaulting to standardized guidelines that may not suit every patient.

For those suffering from migraines or post-concussion headaches, therapeutic Botox offers a highly effective, minimally invasive solution. As awareness grows and more physicians advocate for its use, the hope is that this game-changing treatment will become more widely accessible to those who need it most.

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Please visit our Patient Stories page, and specifically Tara's story, Natalie's story, and Devan's story to learn more about how treatment with Botox Therapeutic has improved our patients’ lives.

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June is Brain Injury Awareness Month. If you’re suffering from Post-Concussion Syndrome (PCS), chronic migraines, or other chronic headache conditions and you're interested in whether Botox® Therapeutic may be a solution, please contact us to book a consultation.

Please note: because it’s not currently covered under the provincial health care plan, we recommend that patients inquire with their insurance about coverage prior to your consultation. Forms required to qualify for third-party coverage can be completed by your family doctor, or Dr. Ray can complete the necessary paperwork at a fee not covered under the medical plan. Again, please contact us for more information; we’re happy to help!