Could Botox Help My Vestibular Migraines?—Part 1

Photo by Raghavendra V. Konkathi on Unsplash

“Have you ever tried Botox?” he asked me. I raised an eyebrow questioningly. “Do you know what Botox is?” he continued, filling my pause. “Arrugas… what is this word in English?” 

I quickly brought my hands to my face to cover my forehead. “Wrinkles,” I replied. “Arrugas is wrinkles in English.” I was smiling, It was my first time consulting with this neurologist about my vestibular migraines and I recognised his intention to lighten the discussion. 

A Migrainous Past

The last time I saw a neurologist for vestibular migraine was a few years ago when I lived in Madrid and was struggling with constant imbalance. I was sure my everyday difficulties with coordination and balance were not being caused by my Meniere’s disease, which typically hits me more sporadically with increased tinnitus and vertigo.

During this time, I often felt that I appeared drunk when I was walking. Perhaps this was just how I felt. I was struggling every time I went outside for a walk. This was more severe than my usual feeling off-balance around crowds of people, bright lights or busy environments. When out and about, the pavement would seemingly raise towards me with every few steps. My head and ears were constantly full of pressure, always more pronounced on my left side—the side with no hearing. The left side of my brain felt like it was being squeezed and I couldn’t help but worry that this condition was causing damage. 

Under the care of my neurologist in Madrid, I trialled some medications and also employed healthy habits which included reducing screen time, practising yoga, getting outside in the morning light, and carrying out controlled breathing exercises. I was already eating healthily and was physically active, though I had to approach strenuous activity with caution. Running, something I once enjoyed, now presented a high chance of falling and possible repercussions, such as feeling drained and increased head pressure. Yoga and walking became my exercises of choice. With time, I found a medication to help stop the floor from performing its antics and I started to feel more stable. After 6 months or so, my brain had retrained and steadied itself, and I was able to gradually come off the medication. I was even able to start going for a gentle jog. I was doing ok, until about a year ago.

More Migraine Days

Since moving from Madrid to the east coast of Spain, I have been struggling again with the everyday feeling of pressure in my head. This area of Spain, being both mountainous and coastal, delivers a vibrant cocktail of weather patterns. I feel it is the changeable weather that affects my vestibular migraines more than anything. Every time there is a significant change in barometric pressure, my body tells me. A human barometer, I always know when a storm is coming. 

The feeling of pressure is there all of the time. It fills my left ear and squeezes the left side of my brain; this is my every day, or rather a good day. I am always tired. 

On a mediocre day, the pressure increases and I become more imbalanced and sensitive around visual stimuli, lights, and sounds. I experience pain behind my left eye and I struggle to concentrate. 

On a bad day, I feel fatigued. I jumble my words. The brain squeeze is intense and painful, and the pressure fills both my ears. My neck is stiff and sore. My tinnitus increases. I’m lightheaded though my head feels heavy. I feel detached from my body. My vision is blurred. I have difficulty controlling my movements. I’m slow to react. I can’t concentrate on my writing. I can’t look at the laptop screen. I become frustrated. I think about all the tasks I wanted to do on these days but have to make peace with the fact that some days I have to rest… My desire to be productive is always much more than my ability. 

I have spent most of my days for the last year moving between mediocre and bad days. I recall one good day in the past three months—walking in the mountains, feeling awake, without a cloud in my brain. Smiling, constantly checking in with myself and realizing I still felt good. I couldn’t help but comment on how well I was feeling all day. I cling to this memory, hoping the next day will be like this one. It amazes me that many people wake up in the morning and feel ok, refreshed even. I long for a day like this. 

Smoothing Out the Wrinkles

“Botox, for my migraine?” I ask. The neurologist explains to me that approximately 80% of people with migraine will feel some benefit from having Botox injections in specific areas of the head and neck, every 3 months. 

I have found it difficult to find a specialist with experience treating vestibular migraine since it presents differently from classical migraines, which involve a sharp or throbbing headache. The neurologist explains that there are many types of migraines in addition to the classical type. Some migraine presents with temporary paralysis, and others with temporary sight loss. In my case, it is this feeling of building pressure in my head that causes discomfort and distress. 

Doctors believe that Botox injections work by blocking the pain signals to the brain. The neurologist felt that it could also tackle the feeling of pressure I was experiencing. If the injections help, I wouldn’t have to take any medication—botox would be my migraine prevention. 

“But, would it smooth the lines on my forehead?” I ask. “Sure!” he replied lightly. We’re both smiling, but it’s clear he understands the new hope this treatment option brings me.