Botox for Chronic Migraines

Botox is FDA-approved for chronic migraines (headaches on 15 or more days a month), since 2010. Botox is not recommended for patients who experience fewer than 15 headache days a month. Botox is a form of botulinum toxin, a neurotoxin produced by the bacteria that causes botulism. When the botulinum toxin is purified and used in tiny doses in specific areas, it temporarily reduces muscle contractions for approximately 3 months.

Botox is injected around pain fibers that are involved in headaches. Botox enters the nerve endings around where it is injected and blocks the release of chemicals involved in pain transmission. This prevents activation of pain networks in the brain.

Botox prevents migraine headaches before they start, but takes time to work. Patients will see a decrease in headache frequency with an increase in the number of treatment cycles. One treatment lasts for 10-12 weeks.
In general, the FDA-recommended dosage is 155 units. The doctor uses a very small needle that feels like a pinprick and injects small amounts of Botox into shallow muscles in the skin. Each treatment typically involves 31 injections in seven key areas of the head and neck.

The most common side effect from the Botox shots is a sore neck, and we recommend using an ice pack to reduce the discomfort.

Because Botox is FDA approved for chronic migraines, it’s covered by most plans, including Medicare and Medicaid. Before your insurance approves Botox as a treatment for your chronic migraine, you typically must have tried and failed two other preventative treatments (anti-seizure medications, antidepressants, or blood pressure medications).