How it works
How Botox for chronic migraine works
Botox (onabotulinumtoxinA) is a prescription medicine that is approved by the U.S. Food and Drug Administration (FDA) to prevent headaches in adults with chronic migraine. It is not a treatment for a migraine attack that has already started. Instead, it is given on a regular schedule and aims to reduce how many headache days you have.
The medicine is injected into several muscles of the forehead, temples, back of the head, neck and upper shoulders. It is thought to block some of the signals involved in migraine pain.
Botox for chronic migraine is one part of a migraine care plan. Your provider can talk with you about how it fits with your other treatments.
Who may benefit
Who may be a candidate for Botox for chronic migraine
Botox is approved for adults with chronic migraine, which means:
- headaches on 15 or more days a month, and
- headaches that last 4 hours a day or longer on those days.
It has not been shown to help people who have migraines on 14 or fewer days a month, so it is not used for that.
You may be a candidate if you have chronic migraine. You do not always need to try other preventive medicines first; it varies from person to person. Your provider will look at your headache history, your medicines and what you have already tried, then talk with you about whether Botox makes sense. Keeping a headache diary before your visit can help.
Tell your provider if you have had a reaction to any botulinum toxin product, have a muscle or nerve condition, have trouble swallowing or breathing, or are pregnant or breastfeeding.
What to expect
What to expect at a Botox treatment visit
Before your treatment
You will meet with your provider to review your headache history, your medicines and any allergies. Bring your headache diary if you keep one. Your team will tell you how to prepare and will handle any prior authorization your insurance plan needs.
During the treatment
Your provider gives a series of small injections with a very fine needle into set areas of the forehead, temples, back of the head, neck and upper shoulders. You may feel a brief sting with each one. The injections usually take 30 minutes or less.
After your treatment
You can usually go back to your normal activities the same day. You may have mild soreness, redness or bruising where the needle went in, or a sore or stiff neck. Keep tracking your headaches so you and your provider can see whether the treatment is helping. Treatments are usually repeated about every 12 weeks, as your provider recommends.
Keep taking your other migraine medicines unless the clinician who prescribes them tells you otherwise.
Benefits and limitations
Possible benefits and limitations
The goal of Botox for chronic migraine is fewer headache days and headaches that disrupt your life less.
People vary a lot. Some notice a change after the first treatment, and others need more than one round before a change shows. How much it helps varies from person to person, and some people do not get the relief they hoped for. Your provider will review your headache diary with you to judge whether to continue.
Risks and side effects
Risks and side effects of Botox for chronic migraine
Common side effects include neck pain, headache, soreness where the needle went in, tiredness, muscle stiffness or weakness, and a drooping eyelid or brow.
Rarely, the medicine can spread beyond the injection area and affect other muscles. This can cause serious problems with swallowing or breathing. Botox carries an FDA warning about this.
Please talk with your provider about the risks that apply to you before deciding.
When to seek emergency care
Call 911 or get emergency care right away if, in the weeks after a treatment, you have trouble swallowing, breathing or speaking, muscle weakness all over your body, double or blurred vision, or a change or loss of your voice.
Other options
If Botox is not the right fit
Your provider can talk with you about other options based on your headaches, your goals and what you have already tried.
Common questions
Questions about Botox for chronic migraine
Your provider can talk through your own plan at your visit.
Who can get Botox for migraines?
Botox is approved for adults with chronic migraine: headaches on 15 or more days a month that last 4 hours a day or longer. It is not used for migraines on 14 or fewer days a month. Your provider decides with you after reviewing your headache history and what you have already tried.
How is Botox for chronic migraine given?
Your provider gives a series of small injections with a very fine needle into muscles of the forehead, temples, back of the head, neck and upper shoulders. You may feel a brief sting with each one. Treatments are usually repeated about every 12 weeks, as your provider recommends.
How long does it take for Botox to help migraines?
It varies. Some people notice fewer headache days after the first treatment, and others need more than one round before a change shows. Keeping a headache diary helps you and your provider judge whether it is working for you.
What are the side effects of Botox for migraines?
Common side effects include neck pain, headache, soreness where the needle went in and a drooping eyelid. Rarely, the medicine can spread and cause trouble swallowing, breathing or speaking, which needs emergency care. Your provider will go over the risks that apply to you.
Is Botox for chronic migraine covered by insurance?
Coverage depends on your plan, and some plans need a prior authorization before treatment, such as a record of other medicines you have tried. Our team handles prior authorization requests with your plan.
Clinical references
Individual results are not guaranteed and may vary from person to person. This page shares general information. It is not medical advice and does not replace a visit with a qualified clinician.