If you’re getting headaches 15 or more days a month, Botox might be an option worth exploring. This treatment is approved for chronic migraine and can cut the number of headache days for many people. Below I explain how it works, who should consider it, what the procedure feels like, and what to ask your doctor.
Botox (onabotulinumtoxinA) is not a painkiller. It works by blocking certain nerve signals and reducing muscle tension in areas around the head and neck. For people with chronic migraine—usually defined as 15+ headache days per month, with at least 8 migraine days—regular Botox injections can lower how often and how badly migraines hit. Clinical trials show many patients see fewer headache days and need less rescue medication after treatment.
A typical Botox session takes 10–20 minutes. Your provider injects small amounts into about 7 specific head and neck sites; the usual total is around 155 units. Treatments are repeated every 12 weeks. You might notice improvement after 2 weeks, with the full effect by 6–8 weeks.
Common side effects are mild and local: soreness at injection spots, neck pain, or a temporary droop in an eyelid or eyebrow. Serious complications are rare when a trained clinician does the injections. Don’t get Botox if you’re pregnant, breastfeeding, or have certain neuromuscular disorders—talk these through with your doctor.
Insurance often covers Botox for chronic migraine, but many plans require prior authorization and documentation of failed trials with other preventives. Keep records of headache days and past treatments to speed approval.
Not everyone benefits. People with episodic migraine (fewer than 15 headache days per month) usually don’t get Botox for prevention. If you have frequent migraines and haven’t tried other preventive options like beta blockers, topiramate, or CGRP inhibitors, your doctor may suggest those first.
Practical tips: go to a neurologist or headache specialist who injects Botox regularly. Ask how many units they use, where they inject, and how many patients they’ve treated. Expect to track your headache days in a diary—this helps judge whether Botox is working and helps with insurance.
Alternatives include oral preventives, CGRP monoclonal antibodies, nerve blocks, and lifestyle changes (sleep, hydration, stress management). Sometimes combining Botox with other treatments gives the best results.
Bottom line: if migraines take up a big chunk of your life, Botox can reduce how often they happen and how intense they are. Talk with a qualified provider, check insurance coverage, and keep a clear headache record so you and your clinician can see if the treatment is helping.
In 2025, there are several effective alternatives to Topiramate for individuals seeking relief from migraines. Botox, known for its migraine prevention, offers a unique approach with injections targeting specific muscles. While it shows high efficacy, potential side effects like facial asymmetry and higher costs may be drawbacks. Exploring such alternatives is essential for those in need of viable solutions.
