Josh Malam has no trouble easing pain for other people. The 31-year-old has worked as a massage therapist for three years, but it took him almost a decade to find the right treatment for his own pain.

"Hard to function - hard to think. Can't get through my day. Essentially, just lock myself in my room,” said Malam.

It can hurt for hours or weeks at a time. Malam lives with chronic migraine, where frequent headaches are so severe, they render him unable to work or socialize.

“(People) wouldn't believe you or they would think you could just get through it. You know, ‘Just push a little bit harder.’ The common response is always, ‘Take a Tylenol,’” said Malam.

Neurologist Dr. Behzad Mansouri said this stigma from other people, and even among patients themselves, prevent many living with chronic migraine from seeking professional help.

“We know that 90 per cent of people will experience migraine at some point, severe migraine, at some point,” he said. “Fifty per cent of these patients report that their headache is so severe that they have to be bedridden.”

In North America, 18 per cent of women and six per cent of men in the general population suffer from migraine.

Only those who experience 15 or more days of headache – eight of which must be migraine – a month, for a period of three months, are diagnosed with chronic migraine.

Treatment typically starts with recognizing and working on controllable triggers such as fatigue, workload and diet. If the pain persists, short and long-term medications are prescribed before one of the newest treatment options becomes available - Botox injections.

And these are far from cosmetic.

"This involves a number of muscles in the face, head, temples, back of the head and neck muscles," said Dr. Satnam Nijjar, a Winnipeg neurologist who administers Botox treatment.

In total, around 30 injections are used in one treatment. Neurologists who spoke to CTV said it’s safe. Only a small dose (200 units) of the toxin is used and it doesn't enter the blood stream.

In two clinical trials done in the United States, Botox was shown to reduce the severity and frequency of chronic migraine pain.

But even after Health Canada approved the treatment in 2011, barriers still remain.

”Unfortunately, it's not something that is covered here by Manitoba Health," said Nijjar.

A round of Botox can run upwards of $1,200. Patients are encouraged to do at least two sessions to fairly evaluate whether or not their pain has improved.

“(The hypothesis is) that if someone has migraine for a long time, their brain changes and the network for pain is more sensitive. That’s why they have more and more pain. So with Botox, the idea is to calm that network in the brain,” said Dr. Mansouri, who is studying the effects of Botox on the brain at the University of Manitoba.

"(During migraine) there is a spreading depression wave, so it's not just migraine, the brain actually decides to shut down for some time,” he said.

It can take hours or days to feel normal again. Mansouri said that's why many who live with the condition miss work, or do not perform at an optimal standard.

In the United States, it amounts to 100 million hours of missed work or school. A cost of $13 billion annually, said Mansouri.

Those days have diminished for Malam, who said he hurts less after his two rounds of Botox and has another planned in a few weeks.

"I noticed that the muscles weren't as taut, weren't as tight,” he said.

For many, the pain isn’t only physical. Both neurologists who spoke with CTV said people living with chronic migraine are more vulnerable to anxiety and depression.

More medical information on headaches is available on the WHO's website and on the WRHA's website.