Botox for Migraine Treatment

Medically Reviewed by Jabeen Begum, MD on January 20, 2025
7 min read

Botox is the most widely known brand name for botulinum toxin type A injections. Botulinum toxin is a neurotoxin made by a species of bacteria called Clostridium botulinum. It works on your nerves to paralyze your muscles. It's been used for decades to smooth fine lines and wrinkles around your face and head. The toxin reduces muscle contractions in the areas into which it's injected, offering relief for about three months at a time.

People with migraine headaches who got Botox injections for wrinkles reported getting fewer headaches than before they had Botox.

In 2010, the FDA approved Botox injections to help prevent headaches in adults with chronic migraine. Chronic migraine is when you have a headache on 15 or more days per month, with at least eight of those days involving your usual migraine symptoms. For Botox treatment, you'll usually get around 30 small injections into key areas around your face, head, and neck. You usually need to repeat this treatment every 10-12 weeks. And it may take six months before you notice a difference.

Botox for migraine treatment isn't a cure, but it can be part of your migraine management strategy if you have chronic migraine. Keep reading to learn the answers to some questions you may have about Botox for migraine headaches.

Studies show that many people with chronic migraines have a headache on fewer days each month after Botox injections. In one study, nearly half the people who took two cycles of Botox shots reported that they had headaches about half as often as before Botox. After five cycles of treatment, about 70% of the participants said that they had headaches half as often.

Other people said that their headaches were less severe after Botox, improving their overall quality of life. They said:

  • They had fewer days in the month with a migraine or headache.
  • Their headaches didn't last as long.
  • They had fewer days with moderate to severe headaches.

How long do Botox injections last for migraines?

One cycle of injections lasts about 10-12 weeks.

 

Experts don't know exactly how Botox works to prevent migraines. But they think that Botox enters your nerve endings near the area where it's injected. For migraines, it's usually injected into muscles in your forehead, scalp, neck, and shoulders.

Once it enters the nerve cells in your muscles, it stops them from releasing chemicals called neurotransmitters. These neurotransmitters are pain signals that travel to your brain, causing headaches. Since Botox stops your muscles from sending out these pain signals, it helps you have headaches less often.

You should only get this type of Botox treatment from a headache specialist or a neurologist.

One cycle of injections is about 30-40 small injections around your face, head, and neck. Your appointment should last around 20 minutes.

Your doctor will use a very small needle that may sting like a pinprick. They will inject a very small amount of Botox into the shallow muscles very close to your skin in about seven places around your head and neck. You could see results two to three weeks after your first treatment.

Where do they inject Botox for migraines?

You will usually get 30-40 small injections in your:

  • Forehead
  • Above your ears and around your temples
  • At the back of your head and nape of your neck
  • Down each of your shoulders

Sometimes, your doctor may inject into an area called a trigger point, where headache pain is thought to start. If you know you have specific areas where your headaches start, tell your doctor. They may want to concentrate your injections around this area if it's possible.

Does Botox for migraines change your face?

Depending on where you get your injections, Botox may spread a little into nearby tissues. This could lead to side effects, such as a drooping eyelid or eyebrows that look out of place. Some people may notice a slight change in the expression lines on their forehead. Usually, any change you notice is likely to be subtle. Your doctor may be able to change your injection sites slightly if this happens to you.

What not to do after Botox for migraines?

Avoid the following for the first 24 hours after each cycle of your Botox injections:

  • Rubbing the areas where you got your injections
  • Vigorous exercise, such as jogging, jumping rope, or lifting heavy weights
  • Washing your hair
  • Washing your skin in the areas where you got injections
  • Getting a massage or sitting in a sauna

This helps prevent you from getting an infection and it gives the Botox time to fully absorb at your injection sites.

Botox injections don't permanently stop your migraines. After about 10-12 weeks, the nerves in your muscles that the Botox blocked can repair themselves. Your headaches will likely return after that unless you have another cycle of injections. You may need to get two to three treatment cycles of injections before you notice the full effect.

The full effect is usually a 30%-50% reduction in the number of days during which you have a headache. So, if you typically have headaches 15 days per month, Botox could reduce that to 8-11 days per month. But as you have more cycles of injections, you should notice you have headaches on fewer days of the month.

Some people can stop getting injections after a few cycles without their migraines coming back. Other people may need to have injections regularly to keep their migraines at bay.

Don't use Botox or other botulinum toxin injectables if you are:

  • Pregnant
  • Nursing an infant
  • Allergic to proteins in cow's milk

Botox is generally pretty safe and most people tolerate them well. Some common side effects include:

  • Pain, bruising, or swelling at your injection sites
  • Neck pain or weakness
  • Shoulder weakness
  • Headache or flu-like symptoms
  • Dry or watery eyes
  • Drooping eyelid, eyebrow, or on the side of your mouth
  • Drooling

It's rare, but you can have an allergic reaction to Botox. Signs of this can be hives, shortness of breath, or swelling in your lower legs.

It's very rare, but Botox can spread further than your nearby tissues. If that happens, you may have more serious side effects. Get to a doctor right away if you have:

  • Changes in your vision
  • General muscle weakness
  • Trouble speaking or swallowing
  • Trouble breathing
  • Loss of the ability to control your bladder

Does Botox for migraines cause weight gain?

No, Botox isn't likely to cause weight gain. Botox is not absorbed into your bloodstream; it tends to only affect the nerves near where you got your injections. This means you won't usually have side effects in more distant parts of your body. So, it's unlikely, for instance, to increase your appetite or make you retain water.

Your costs will depend on many different things, including what types of insurance you have and what your insurance will cover. According to the American Migraine Foundation, Botox for migraines generally costs anywhere from several hundred to several thousand dollars per treatment cycle.

If you don't have insurance, you may be able to qualify for a program run by the drug company to provide low- or no-cost medicines. The maker of Botox, AbbVie, also has a Savings Program to help cover the cost of your copay if you do have insurance. Visit AbbVie's website at Botox Cost & Savings to learn more.

Does insurance cover Botox for migraines?

Yes, it should be covered by most insurance plans (including Medicare and Medicaid) since it is FDA-approved for the treatment of chronic migraine. 

But you have to meet the criteria for chronic migraine to qualify; that is, for at least three months, you must have had a headache on 15 or more days per month, with at least eight of those days involving migraine symptoms. Also, you will usually need to have tried two other types of preventative medicine without having significant benefits before they will cover it.

Other types of preventative treatment you may have tried include anti-seizure medicines, antidepressants, and some blood pressure medicines. Make sure you let your headache specialist know if your primary care doctor and you have tried any of these to help prevent your headaches.

Botox is a neurotoxin that your doctor can prescribe to help prevent headaches if you have chronic migraine. Studies show that people who have Botox injections for their migraines say that they have fewer headache days in general. They also say they have fewer days with severe headaches. If you have chronic migraine and have tried a couple of other methods for preventing your headaches, talk to your doctor. Botox may be an option in your migraine management plan.

What is the downside of Botox for migraines?

Botox injections can be expensive, costing hundreds to thousands of dollars per treatment cycle. It should be covered by most insurance companies since it's FDA-approved for chronic migraines. To qualify, you usually must:

  • Meet the criteria for chronic migraine
  • Have tried a couple of other medicines to prevent migraines first

If you have headaches on at least 15 days per month — and on at least 8 of those days, you have your typical migraine symptoms — then you may have chronic migraine. Talk to your doctor about it if you're not already diagnosed. If you don't have insurance, you may qualify for assistance from the drug manufacturer.