Pain Management Procedures
Botox for Chronic Migraine
Botox for Chronic Migraine
What is Botox treatment for migraine?
OnabotulinumtoxinA, commonly known by the brand name Botox, is an FDA-approved preventive treatment for adults with chronic migraine. It works by reducing the release of chemicals involved in pain signaling. This is a medical treatment using a standardized pattern of injections; it is different from cosmetic Botox.
Who is it for?
The FDA indication is prevention of headaches in adults with chronic migraine - generally 15 or more headache days per month, with headaches lasting four hours a day or longer. It is not approved for episodic migraine with 14 or fewer headache days per month. A headache diary can help document frequency and response, and insurers may require trials of other preventive medicines first.
What happens during treatment?
A standard session uses 155 units divided among 31 small injections across seven head and neck muscle areas. The injections take only a few minutes, and no general anesthesia is needed. The usual retreatment schedule is every 12 weeks when treatment is effective and medically appropriate.
When should I expect improvement?
Botox is preventive, not a rescue treatment for a migraine already underway. Improvement may take days to a few weeks, and some people need more than one treatment cycle before the benefit is clear. The goal is fewer or less severe headache days, not a guaranteed end to all migraine attacks.
Important risks
Common side effects include neck pain, injection-site discomfort, temporary muscle weakness, headache, or eyelid droop. Rarely, toxin effects can spread beyond the injection area and cause generalized weakness, trouble swallowing, speaking, or breathing. Tell the clinician about neuromuscular conditions, prior botulinum toxin treatment, and all medicines. Seek urgent help for swallowing or breathing difficulty.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.