Edwardsville patients are treated at the Headache Express clinic across the river in St. Louis, Missouri. The visit covers migraine and whether Botox for chronic migraine applies, nerve blocks where the diagnosis supports them, and preventive treatment, coordinated with your own physician.
Edwardsville sits close to the I-270 corridor, which makes the crossing to the Missouri side and on to Woodson Road one of the more direct runs from Madison County.
Who qualifies for Botox for migraines?
More treatment decisions turn on headache days per month than on how severe the attacks are. Fifteen or more headache days a month, of which at least eight have migraine features, sustained beyond three months, is chronic migraine. Below that line it is episodic.
This is not bureaucratic hair-splitting. Botox is indicated for chronic migraine and not for episodic, because the trials in people below fifteen days did not demonstrate benefit. See chronic or episodic migraine.
Why people undercount and lose access
The count includes headache days of any type and any severity — not just the days you lost. The mild days you worked through, the ones you treated early and forgot about, the dull background ache on waking: all of them count. Undercounting is the single most common reason someone is told they do not qualify for a treatment they would in fact qualify for.
Bring a month of counted days rather than an estimate. A calendar with a mark on it beats a recollection every time. What the injection protocol actually involves is described in who qualifies for Botox.
What if I don’t qualify for Botox?
Then Botox is not indicated and we will say so rather than stretch the criteria. The conversation moves to acute treatment that works and to prevention appropriate for episodic migraine — see Botox for chronic migraine for the boundary, and headache prevention for what else is available.
What does Botox for migraines involve?
It is a defined protocol rather than a cosmetic injection: a fixed set of sites across the forehead, temples, back of the head, neck and shoulders, repeated at roughly twelve-week intervals. It is a preventive, so it does nothing for the attack you have today and its effect is judged over cycles rather than days.
Two cycles is the usual honest trial. People abandon it after one because nothing obvious happened, which is the most common reason a treatment that would have worked gets recorded as a failure.
The procedure itself and who qualifies cover the detail, including the headache-day threshold that governs access to it.
Can chronic migraine go back to episodic?
The transition is not random. Frequency creeps up over months, usually alongside rising acute medication use, until the pattern crosses a line and gets a different name and different treatment options.
The useful part is that it runs in both directions. Chronic migraine converts back to episodic in a meaningful proportion of people when the drivers are addressed — acute medication brought under control, sleep stabilized, a preventive given a fair trial.
Chronic versus episodic migraine covers what separates them and why the count matters more than the severity of any single attack.
Do nerve blocks work for headaches?
It depends entirely on which headache is being treated, and lumping them together is how the question gets answered badly in both directions. For occipital neuralgia the case is strong and the mechanism is obvious. For cluster headache there is good support for specific targets. For ordinary episodic migraine the picture is more mixed and we say so.
Do nerve blocks for headache work goes through it by diagnosis rather than offering a single verdict. The practical consequence is that a block should be proposed for a reason you can be told, not as a default next step.
Counting headache days honestly
Access to several preventive treatments is governed by a threshold of headache days per month, which makes the count consequential rather than academic. It is also routinely wrong.
People discount the days they managed to work through, and they discount days where medication worked, on the reasoning that it was not really a headache day. Both count. Under-reporting by three or four days a month is enough to put someone on the wrong side of a threshold and out of reach of the treatment that would have helped.
Chronic versus episodic migraine covers where the line sits and why it is drawn there.
If you are already on a preventive
Bring the history of what has been tried, at what dose, for how long, and why it was stopped. That last part is the one that gets lost, and it changes everything — a drug abandoned at two weeks for a side effect was never actually trialed, and it may still be the right answer at a different dose.
A preventive needs eight to twelve weeks at an adequate dose before it can be called a failure. A great many people arrive having been through six of them, none of them properly.
Coordinating with your own physician
Nothing here replaces your primary care physician or your neurologist if you have one. We share findings back, and where a preventive is started we say explicitly who is managing it so two people are not adjusting the same drug.
Where a headache turns out to be secondary to something else, that goes back to the right specialty rather than being treated here because you happened to arrive here.
Next door, headache treatment for Glen Carbon deals with headaches that grow more frequent while you treat them.
Common questions
How long before I know whether Botox is working?
Plan on two to three cycles, roughly six months. Benefit accumulates rather than arriving at once, and judging it on a single round is the most common mistake. See who qualifies.
Is this the same as cosmetic Botox?
No — different injection sites, different dose, different purpose. A cosmetic pattern does not treat migraine. See Botox for chronic migraine.
Can I combine it with nerve blocks?
They are not mutually exclusive and do different jobs, one preventive and one often diagnostic. Which combination fits depends on your pattern — see occipital nerve block.
What disqualifies you from Botox for migraines?
Fewer than fifteen headache days a month. Botox is indicated for chronic migraine: fifteen or more headache days a month, at least eight with migraine features, for more than three months. Below that line the migraine is episodic, and we say so rather than stretch the criteria. Count every headache day, including mild ones and days medication worked, because undercounting is the most common reason people are wrongly told they do not qualify.
What is the downside of Botox for migraines?
It is slow. Botox is a preventive, so it does nothing for the attack you have today, and its effect is judged over treatment cycles rather than days. Benefit builds across two to three cycles, roughly six months, which is why people who stop after one round often record a treatment that would have worked as a failure.
How often are Botox injections for migraines repeated?
Roughly every twelve weeks. Each session follows a defined protocol: a fixed set of injection sites across the forehead, temples, back of the head, neck and shoulders. It is a different pattern, dose and purpose from cosmetic Botox. Two cycles is the usual honest trial before judging whether it is working.
How long should a migraine preventive be tried before it counts as a failure?
Eight to twelve weeks at an adequate dose. A drug stopped at two weeks for a side effect was never really trialed, and it may still be the right answer at a different dose. Bring the history of every preventive you have tried: the dose, how long you took it and why it was stopped. That last detail changes the plan most.