The Consumer’s Guide to Botulinum Toxin for Chronic Migraine

The FDA approved Botox in 2010 for the prevention of chronic migraine in people age 18 or older. “There are other botulinum toxins available, but they haven’t been studied for migraine,” says Andrew Michael Blumenfeld, MD, director of the Headache Center of Southern California.

Getting poked with a needle is never fun, but rest assured, the needle is small, similar to an acupuncture needle. And the injections are superficial, so they shouldn’t hurt too much, says Dr. Blumenfeld. Patients typically receive a total of 31 injections every 12 weeks, which may sound like a lot, but a skilled practitioner should be able to administer them quickly, in five minutes or less. “The patient is seated in a chair, and I talk to them during the procedure to keep them relaxed,” says Blumenfeld. “The forehead and head injections may hurt a little, but the neck and shoulder ones are hardly anything but a little pinch.”

Botox injections can help decrease the frequency and severity of migraine. One review, published in June 2018 in the Cochrane Database of Systematic Reviews, found that botulinum toxin type A may reduce the number of migraine days by two per month. Still, the injections aren’t a quick fix. It can take weeks or months and multiple treatments to notice an improvement in your symptoms.

“Most people see a sequential improvement over time, meaning the second treatment is more effective than the first, and so on,” says Blumenfeld. “The more severe your migraines are, the more treatments you might need.” For example, he says, the intensity of your migraines could decrease from a 10 on the pain scale to about a 5; if you want better results, in this case you’ll need additional injections. For some people, Botox may resolve migraine completely, but it may take a few years.

When given by an experienced practitioner, Botox injections for chronic migraine appear to be safe, with no known long-term side effects, says Emad Estemalik, MD, section head for headache and facial pain at the Center for Neurological Restoration at Cleveland Clinic. That said, there can be short-term side effects. “The most common one I hear is neck discomfort and weakness,” says Dr. Estemalik. “You may also experience a headache immediately after the procedure, but it usually subsides in a few days or weeks, as the treatment kicks in.” Other side effects may include pain, swelling, or bruising where the drug was injected; flu-like symptoms; watery or dry eyes; drooping of one eyelid or eyebrow; and drooling.

If you’re pregnant or nursing, you should avoid Botox injections, but they can be administered in dire circumstances. “I’ve done them when the migraines get worse and threaten the pregnancy,” says Blumenfeld. “But ordinarily, I don’t give them during pregnancy.”

Because the FDA approved Botox for the treatment of chronic migraine, most insurance carriers, including Medicare and Medicaid, will cover the treatment. But they may require you to try at least two or three other preventive medications before covering the injections, says Estemalik. Once you’ve tried other drugs that either didn’t work or had intolerable side effects, your insurance carrier should cover Botox for chronic migraine prevention, he says.

Even if your insurance provider covers Botox, you’ll still be responsible for any copays or deductibles. If you don’t have insurance, the list price of the medication is more than $1,200, plus whatever your provider charges to do the procedure.