Botox For Migraine: Everything You Need To Know
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I have been getting Botox for migraine every three months since 2017. It has helped me 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 an FDA-approved prescription treatment used to prevent migraine attacks in adults with chronic migraine. The doctor administers the injections every 12 weeks. According to official Botox clinical trial data, Botox reduced headache days by an average of eight to nine days per month at week 24, compared with six to seven days with placebo.
According to the American Migraine Foundation, doctors inject Botox around pain fibers involved in migraine. Botox enters the nerve endings and blocks the release of chemicals involved in pain transmission. This helps prevent the activation of pain networks in the brain.
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.
Many insurance companies require the following to approve Botox for migraine:
1. You need to have a history of chronic migraine.
Currently, Botox is FDA-approved for adults with chronic migraine and not approved for episodic 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.)
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. Personally, I use a Notes app on my iPhone. 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 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 31 injections across seven head and neck muscle areas. The chronic migraine protocol is different from cosmetic Botox, although some injection areas may overlap. 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 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 dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, eye problems such as double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes, drooping eyebrows, and upper respiratory tract infection. This is something you should discuss with your doctor.
It is important to see a healthcare professional with experience administering Botox for chronic migraine to reduce your risk of side effects or complications.
How Fast Does Botox for Migraine Work?
Botox for migraine does not work instantly. Some people notice improvement after the first treatment, while others may need two or three rounds of injections before experiencing relief. 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 Complete Savings Program, available to eligible patients with commercial insurance. You may get reimbursement up to $1,400 for the first treatment of the year and up to $1,000 for each subsequent treatment, with a maximum benefit of $4,000 per year. This program has been easy and extremely helpful in making my Botox treatment affordable.
Unfortunately, people enrolled in Medicare, Medicaid, TRICARE, or other government-funded insurance programs are not eligible for the BOTOX Complete Savings Program. Uninsured patients may be able to qualify for the AbbVie 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 inject a local anesthetic, such as lidocaine or bupivacaine, near specific nerves to temporarily reduce pain signals. Some doctors use a local anesthetic alone, while others may add a corticosteroid depending on the type of nerve block and the patient’s individual needs. My doctor uses both a local anesthetic and a steroid for my nerve blocks. My doctor performs my nerve blocks in the office without fluoroscopy or EMG guidance, and the procedure usually takes only a few minutes. Of course, the length of relief varies from person to person.
During trigger point injections, a doctor injects a local anesthetic alone or in combination with a corticosteroid into tight or painful areas of muscle. My doctor uses both a local anesthetic and a steroid. This treatment may be helpful when muscle pain in the neck or shoulders contributes to migraine attacks or referred pain.
In contrast, Botox for migraine involves botulinum toxin injections to the specific muscle areas in the head and neck.
Botox for Migraine During Pregnancy
When I was pregnant with my children and my migraine became chronic, Botox was not presented to me as a treatment option because the research we have today was not available yet. I was trying to manage daily migraine attacks with very few treatment choices and very little guidance. That is why I feel genuinely hopeful when I look at the research available now. Someone navigating pregnancy with chronic migraine today may be able to have a much more informed conversation with their doctors than I did.
One reason Botox may result in less fetal exposure than medications that circulate throughout the body is that it acts locally. According to Dr. Alexander Mauskop of the New York Headache Center, “the amount of Botox given for chronic migraines is measured in nanograms. After injections, it cannot be detected in the blood.” In his New York Headache Blog, he explains why the early pregnancy research was encouraging.
Since then, we have even more reassuring human data.
Most recently, a 2026 systematic review examined 555 pregnancies
involving Botox exposure for migraine and other neurological conditions. The researchers found that pregnancy-loss and fetal-anomaly rates were within the ranges reported in the general population, with no significant adverse effects identified in pregnant patients or newborns. They still emphasized that the available evidence is limited and that Botox should be considered individually when safer or more effective alternatives are unavailable.
A 2025 study published in Cephalalgiafollowed 126 people with chronic migraine who became pregnant while receiving Botox. Ninety-seven chose to continue treatment during pregnancy. Of those, 95 had full-term deliveries and two experienced miscarriages. Among the 29 people who stopped treatment, 28 had full-term deliveries and one experienced a miscarriage. Most importantly, no fetal malformations were reported in either group.
The study also found that everyone who continued Botox maintained good migraine control according to the researchers’ criteria. In comparison, 20 of the 29 people who stopped Botox experienced a migraine relapse during pregnancy.
Another 2023 study published in Neurology reviewed 29 years of pregnancy reports involving Botox for migraine, other medical conditions, and cosmetic use. Of the cases with a known reason for treatment, approximately 30% involved migraine or headache. Among 195 prospectively reported pregnancies involving 197 fetuses, there were 152 live births, 32 spontaneous pregnancy losses, and 13 elective losses. Of the 152 live births, 148 had normal outcomes. Researchers reported one major fetal defect, two minor fetal defects, and one birth complication. The major fetal defect rate was 0.7%, which was comparable with the background rate reported in the general population.
These studies are not perfect. The 2025 study was observational rather than a randomized clinical trial, and the 2023 study relied on reports submitted to a manufacturer safety database. Most of the documented exposures also occurred before conception or during the first trimester, so we still have less information about Botox treatment later in pregnancy.
Still, this is much more information than I had when I was pregnant, and I find it incredibly encouraging. The available research has not identified an increased rate of major fetal defects, and the newest migraine-specific study reported no fetal malformations. That does not mean Botox has been proven completely risk-free during pregnancy, but it does mean that it may be a reasonable option for some people instead of being automatically ruled out.
If you are pregnant or planning to become pregnant, talk with your headache specialist and OB about your individual situation. You may also want to consult a maternal-fetal medicine specialist. Together, you can weigh the available research, the severity of your migraine disease, how well Botox works for you, the risks of stopping an effective treatment, and the other options available. 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.
You can also join our Parenting With Migraine Facebook Support Group to chat with other parents who have navigated migraine treatment during pregnancy.
Can I Use CEFALY With Botox?
With my neurologist’s advice, I have used my CEFALY device alongside my Botox treatment for many years. I usually wait until the injection sites are no longer sore. CEFALY recommends waiting 48 to 72 hours after Botox injections before using the device.
If you are looking to purchase the CEFALY device, Parenting With Migraine subscribers get a 15% discount at this link.
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 I can usually feel 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 much and feel like a pricking sensation. The 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.
Conclusion
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. If you and your doctor decide it may be right for you, it could be worth giving 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.
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