Botox For Migraine: Everything You Need To Know

I have been getting Botox for migraine every three months since 2017. This helped me to reduce the frequency and severity of my migraine attacks. Although Botox is best known for smoothing out wrinkles, it is also an approved and effective preventive treatment for migraine. I hope my experience provides you with guidance if you consider Botox as a chronic migraine treatment.

While I have experienced migraine attacks for most of my life, my migraine became chronic and unbearable during my pregnancies. At the time, I did not have great guidance on safe treatment options for migraine attacks while pregnant. My quality of life deteriorated. I was in a dark place during a time when I should have been full of joy. Eventually, Botox for migraine was one of the treatments that helped me get migraine under control and improved my quality of life.

What is Botox for Migraine?

Botox (onabotulinumtoxinA) for migraine is a prescription medicine doctors inject into muscles. It prevents on average 8-9 migraine days a month in adults with chronic migraine. It is an FDA-approved and effective preventive migraine treatment administered at the doctor’s office every 12 weeks. [1]

According to the American Migraine Foundation, doctors inject Botox around pain fibers involved in migraine. Botox enters the nerve endings, effectively blocking specific chemical signals from your nerves, causing temporary paralysis of your muscles. This prevents the activation of pain networks in the brain. [2]

Are You Eligible for Botox for Migraine?

Speak with your headache specialist or neurologist to find out if Botox for migraine is the right treatment for you and if you are eligible for it. Many health insurance plans cover Botox for migraine. 

Generally, you need to meet two criteria for the insurance company to approved Botox for migraine:

1. You need to have a history of chronic migraine.

Currently, only patients with chronic migraine qualify for Botox for migraine. Chronic migraine is when we experience 15 or more headache days per month, each lasting 4+ hours. (At least 8 must be migraine days.) Botox is not approved for episodic migraine.

Unsure if you have chronic migraine? I recommend you track your migraine attacks and symptoms. Migraine Buddy is a popular app for tracking migraine attacks and symptoms. Cece migraine tracking app is another excellent option, especially for those who use CEFALY (I do!) Share the information you gather with your doctor because they need it to obtain Botox approval from the insurance company.

2. You must have tried multiple preventive medications first without improvement or with side effects. 

The insurance company usually requires you to try at least two other “first-line” preventive medications before approving Botox for migraine. If these medications did not help or caused intolerable side effects, your doctor can work on obtaining your Botox approval.  

Botox for Migraine Injection Sites

People are usually curious where doctors inject Botox for migraine. The doctor generally follows a protocol and administers one dose into 31 injection sites across head and neck muscle areas. While they are not the same sites used for cosmetic Botox, I’ll admit that reducing wrinkles has been a perk. When living with debilitating pain, we must take any perks we can get, right?

Botox for migraine injection sites

Botox for Migraine Side Effects

As with any treatment, Botox for migraine has side effects. According to AbbVie, the manufacturer of Botox, the most common side effects include neck pain, headache, migraine, slight or partial facial paralysis, drooping eyebrows, eyelid drooping, bronchitis, musculoskeletal stiffness, muscular weakness, pain in one or more muscles, ligaments, tendons, or bones, muscle spasms, injection site pain, and high blood pressure. [3] Talk to your doctor about the possible side effects. 

It is important to see a healthcare professional with Botox for migraine experience to reduce your risk of side effects or complications. 

How Fast Does Botox for Migraine Work? 

Botox for migraine does not work instantly; it takes at least two treatments before it will help. Try to be patient and use this time to focus on lifestyle modifications such as S.E.E.D.S. Some patients do not respond to the first two treatments and only start to respond after the third treatment. Be patient, and make sure you give Botox a chance to work for you.

Botox Savings Program

Thankfully, most insurance companies cover Botox for migraine treatments. However, most patients still have some out-of-pocket costs, which may prohibit them from affording this helpful treatment. I encourage you to explore financial assistance programs available to patients with migraine.

I use the BOTOX Savings Program, available to patients with commercial insurance. You may get reimbursement up to $1,000 per treatment and up to $4,000 yearly for anything not covered by insurance. This program has been easy and extremely helpful in making my Botox treatment affordable. 

Medicare patients may qualify for assistance from Medicare. Uninsured patients may be able to qualify for the Patient Assistance Program. 

Botox for Migraine vs. Nerve Block vs. Trigger Point Injections

In addition to Botox, I also use nerve blocks and trigger point injections, all administered by my neurologist/pain management doctor. He recommends that I receive nerve blocks and trigger point injections two weeks before my Botox for migraine. This is because my symptoms begin to return early before my next round of Botox. This plan has been working for us for many years.

As for Nerve blocks, doctors administer a numbing medication (lidocaine or bupivacaine), and steroid into the nerves to block pain signals. The procedure only takes about 5-10 minutes in a clinic without requiring fluoroscopy or EMG guidance. This procedure could relieve pain within a few minutes, and the effects can last weeks to months, depending on the individual. 

During the Trigger Point Injections, the doctor administers a local anesthetic and steroid into the painful muscle to relieve the affected muscle and the area of referred pain. This treatment is beneficial if muscle pain in the neck or shoulders contributes to your migraine attacks.

In contrast, Botox for migraine involves botulinum toxin injections to the specific muscle areas in the head and neck.

Botox For Migraine During Pregnancy 

I encourage you to consult a Maternal-Fetal Medicine (MFM) physician to find treatments that will help you manage your migraine disease during pregnancy. Developing a migraine treatment plan with your team of doctors before you get pregnant can put you in a better place to handle attacks during pregnancy.

In recent years, studies have shown that Botox had no adverse impact on pregnancy outcomes. According to Dr. Alexander Mauskop of the New York Headache Center, “the amount of Botox given for chronic migraine is measured in nanograms. After injections, it cannot be detected in the blood.” In his popular New York Headache Blog, he cites the current studies which suggest that Botox for migraine is safe during pregnancy.

Although more studies are necessary, people have been using Botox for migraine more during pregnancy. Consult an MFM specialist whether it is safe for you to receive Botox during pregnancy.

You can also join our Parenting With Migraine Facebook Support Group to chat with other parents who have received Botox for migraine during pregnancy. 

Can I Use CEFALY With Botox?

Based on my doctor’s advice, I have used my CEFALY device alongside my Botox treatment for several years. I usually wait several days after the treatment when the injection sites are no longer sore. According to CEFALY, there is “no contraindication for using CEFALY with Botox, and CEFALY Technology has not received any reports of side effects or adverse events resulting from the use of both treatments together.” CEFALY does recommend waiting three months after botulinum toxin injections to treat with the CEFALY device.

As with any new treatment, I always recommend asking your medical provider for advice. If you are looking to purchase the CEFALY device, Parenting With Migraine subscribers get a 15% discount with code: parentingwithmigraine.

What To Expect From The Appointment

I have been getting Botox for migraine for many years and wanted to walk you through my typical appointment. Every three months, I get Botox for migraine as a preventive treatment. I drive an hour to Boston to my doctor who has extensive Botox for migraine experience. As with everything, I arrive in the nick of time. I’m a parent with migraine; getting there at the last second is still a victory. I look forward to these visits because my body usually feels when the treatment is wearing off.

A nurse brings me into the appointment room, and I wait a few minutes for the neurologist to come in. He usually follows the Botox protocol but asks me questions to determine whether he needs to inject any additional areas. A few times, he has administered injections into my jaw because of my symptoms at the time. My doctor makes small talk to distract me as he administers the injections.

I usually focus on a point in front of me while taking slow, deep breaths so I sit still. The injections do not hurt and feel like a pricking sensation. treatment takes a few minutes. My doctor usually gives me gauze and an ice pack for my forehead, which I rarely use. 

Before I leave, I schedule my next appointment at the front desk. It helps keep me on a routine and ensures I get my subsequent treatment on time. Afterward, I can drive home alone, though I feel tired for the rest of the day and like to rest. I like to use ice therapy to relieve any discomfort from the injections. I recommend trying Koldtec Halo ($10 off with code: parentingwm10) and TheraIce.


I hope this post has provided insight into Botox as a migraine treatment. I have relied on Botox to help me reduce the frequency and severity of migraine attacks for many years. It has greatly improved my quality of life. It has been most effective as I use it with other treatments such as medications and lifestyle changes. In a 2020 survey, 92% of current Botox users said they wish they had talked to their doctor and started Botox sooner, and 97% plan to keep using it. [4] The only way to know if Botox is the right treatment for you is to give it a shot!

As always, if you have questions about my experience, please reach out! The best places to find me are on Instagram or our Parenting With Migraine Facebook Support Group. 

This article is not sponsored by Botox, Abbvie, or Allergan.
This post may contain affiliate links, meaning, at no additional cost to you, I will earn a commission if you click through and make a purchase.  

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The information, including but not limited to text, graphics, images, and other material on this website, are for informational purposes only. No material on this website is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition or treatment before undertaking a new healthcare regimen. Please don’t ignore professional advice or delay seeking it because of something you have read on this website.

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