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5 Things You Need To Know About Botox for Migraines

By: Dr. Christopher Khorsandi


Chronic migraines are characterized by frequent and severe headaches with a few potential causes. For years, effective treatment options were virtually non-existent and the underlying cause of Migraines was unknown. Chronic migraine sufferers were often constrained to feeling disabled and incapable of leading productive lives. That all changed in the past decade when medical researchers discovered that Botox, the infamous wrinkle smoother, could provide migraine sufferers with powerful, lasting relief.

Botox works by blocking nerve signals to the muscles, which prevents muscle contraction. When Botox is injected into a muscle, it is unable to contract, thereby relaxing that particular area of the face and relieving pressure on small branches of the sensory nerves around your head. While the intent was cosmetic, the relief migraine sufferers experienced was unlike any other treatment before. Those who could not go a few days without a migraine despite multiple medications were able to dramatically reduce migraine incidences for a period of several months. After successful completion of clinical trials, the FDA approved Botox as a treatment option for chronic migraines. Before seeking out Botox for migraine relief, several things need consideration:

  • First the location and type of migraine needs to be identified. There are three main types of migraines that can benefit from Botox. The first type is Frontal Migraines that begin at the eyebrows and radiate to the top of the head. The second type is Temporal Migraines that begin on the side of the head and radiate to the top. Third are the Occipital Migraines that begin in the back of the neck and radiate upwards. Patients can benefit from keeping a migraine log to record the location and frequency of migraines. A fourth type of migraine has been identified, called a Rhinogenic Migraine. These migraines may be due to a deviated septum and will not respond to Botox. The Rhinogenic migraine can fluctuate in severity based on weather, hormonal changes, and allergies. Other treatments are available for Rhinogenic Migraines.

  • Some insurance plans will cover Botox therapy for Chronic Migraines. The FDA criteria for treatment are 15+ headache days every month with the length of each migraine being 4+ hours. Patients with fewer, less severe headaches may be treated, but must understand that this is an “off label” use of Botox, and while generally considered safe, has yet to be fully studied. Examples of commonly accepted “Off-Label” use of drugs or devices include the use of aspirin for prevention of heart disease, and retinoids for skin care.

  • Some patients may experience incomplete migraine relief from Botox therapy. For these patient additional treatments may be necessary. This may include additional Botox injections or evaluation for Migraine Surgery.

  • Botox is not a permanent therapy. The effect of the Botox will gradually wear off over the course of several weeks to several months. The average duration of treatment is 3-6 months. To continue the benefit, regular treatments may be needed.

An individual’s choice to undergo a procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience complications, you should discuss treatment with your plastic surgeon to make sure you understand risks, potential complications, limitations, and consequences of Botox injections. Always seek treatment from a Board Certified healthcare professional. When appropriately administered, Botox injections can be a life-changing, revolutionary treatment option for chronic migraine sufferers. Patients, who respond well to Botox, may be candidates for Migraine Surgery, which can provide even longer-term relief.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.