Migraine Treatments

Botox for Migraine

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Botox for Migraine

Botulinum toxin type A — or, as it’s more commonly known, botox — is quite versatile in its capabilities. It’s widely accepted as a mainstream cosmetic procedure that smoothes wrinkles. It can even be used to stop excessive sweating. 

And since 2010, botox has been an FDA-approved treatment for chronic migraine as well. It’s been shown to effectively reduce the number of migraine days for people with chronic migraine. 

How does it work? Can it potentially work for your migraine? Any potential side effects? Let’s take a look at this popular treatment and its use for migraine. 

How Does Botox Work to Treat Migraine?

A botox treatment typically involves a series of injections of the chemical onabotulinumtoxinA (BoNT-A), a protein secreted by the bacteria Clostridium botulinum. Although the bacterium itself can lead to dangerous conditions such as botulism (a disease characterized by difficulty breathing, muscle weakness, and even paralysis), BoNT-A injections can provide pain relief as well.

The exact mechanism of how this happens is still unknown, but researchers hypothesize that BoNT-A blocks pain fibers around the injection sites, temporarily disabling the release of chemicals that activate pain networks in the brain. It may be that BoNT-A inhibits activation of C-fiber nociceptors (pain receptors located in the dura mater, the thick, outer layer directly under the skull) by interrupting the release of neuropeptides such as calcitonin gene-related peptides (CGRP). This temporary desensitization may play a critical role in helping decrease headache frequency and intensity. 

Who Should Try Botox for Migraine? 

Currently, the FDA has approved botox treatment for adults (people over 18) with chronic migraine, typically as a second-line treatment following treatments such as propranolol, topiramate and/or amitriptyline. Chronic migraine is characterized by headaches that last over 15 days a month, at least 8 of them presenting with other migraine symptoms. Typically ineligible for botox treatment of migraine are people who: 

  • Are pregnant or breastfeeding
  • Have a neurological condition that causes muscle weakness
  • Are sensitive or allergic to the botulinum toxin or have a history of botulism 
  • Frequently use botox for cosmetic purposes as it might interfere with the efficacy of the treatment. (Note: in some cases, even cosmetic use may bring some pain relief; consult your doctor to discuss.) 
  • Are sensitive or allergic to an ingredient in the botulinum toxin product, such as albumin (cow’s milk protein) 
  • Experience iInfection in or around an injection area 
  • Have a bleeding disorder
  • Frequently rely on use of certain muscle relaxants 

How is Botox for Migraine Injected? 

When your doctor clears you for this treatment, seek a neurologist or a headache specialist well experienced in administering botox for migraine. A typical session may consist of a series of approximately 30 shots injected into the forehead, temples, back of the head, and neck. Specific injection points, and the number of shots per area or in total, will be unique to your situation as determined by your specialist. 

An additional set of injections may be administered, using a “follow the pain” approach and considering your “tender points.” Injections are administered on the average of every 3 months. 

How Quickly Does Botox for Migraine Start to Work? 

Although botox cannot cure chronic migraine, it aims to reduce the number and severity of monthly attacks. As is typical with other migraine treatments, it may require up to 6 months (2 sessions) for a person with chronic migraine to see results. 

During treatment, try keeping a headache diary tracking the frequency of your headache days, in order to see the efficacy of the treatment. This can be especially helpful if your treatment is covered by your health insurance plan. 

Any Side Effects in Using Botox to Treat Migraine?

Besides injection-site pain or bruising, a botox treatment may cause possible side effects that include neck pain, headache or flu-like symptoms, dry eyes, and drooling. But botox is typically well tolerated, and most side effects dissipate as it wears off. 

In rare cases, the toxin could spread and cause more serious side effects within your body. If you experience any of the following symptoms, consult your doctor immediately:

  • Muscle weakness
  • Difficulty speaking or swallowing 
  • Loss of bladder control
  • Difficulty breathing
  • Vision problems unlike those that may occur in your typical migraine attack 

How Effective is Botox for Migraine?

According to the American Academy of Neurology and several other clinical trials, botox treatment has been demonstrated effective in reducing headache days. Also, a 2020 review on the treatment reports that because botox’s mechanism of action is different from emerging preventive treatments such as anti-CGRP therapy it can still be a useful tool in your treatment plan. For now, it appears safe when used in conjunction with other migraine therapies and medications. 


Over the past decade, botox has proven to be a popular and well-tolerated treatment for people with chronic migraine. As with any treatment or therapy option, consult your doctor or specialist to determine if and when it’s right for you, or to share your questions or concerns about the use of botox to treat your migraine. 

Want to learn more about other treatment options? Check out the Mable blog

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  1. “Botox for Migraine.” American Migraine Foundation, https://americanmigrainefoundation.org/resource-library/botox-for-migraine/
  2. Shaterian N; Shaterian N; Ghanaatpisheh A; Abbasi F; Daniali S; Jahromi MJ; Sanie MS; Abdoli A. “Botox (Onabotulinumtoxina) for Treatment of Migraine Symptoms: A Systematic Review.” Pain Research & Management, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/35401888/
  3. Becker, Werner J. “Botulinum Toxin in the Treatment of Headache.” Toxins, MDPI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766412/
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  7. “Botulinum Toxin Injectables for Migraines.” Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/botulinum-toxin-injectables-for-migraines
  8. “Botox for Chronic Migraine.” Headache Australia. https://headacheaustralia.org.au/botox-for-migraine/
  9. “American Academy of Neurology.” AAN. https://www.aan.com/

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Updated on
October 5, 2022
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