A young male hispanic student is suffering from a headache. He sits outside on a bench and massages his head with his hands, grimacing from pressure and tension.
Botox® (onabotulinumtoxinA) is an injectable treatment approved for adults with chronic migraine. A chronic migraine is defined as 15 or more headache days per month, each lasting at least 4 hours. It is given as multiple injections across specific head and neck sites every 12 weeks. While Botox can help reduce the number of headache and migraine days, it does not cure migraines, and its effects are temporary.
At the Gold Coast Headache & Migraine Clinic™, our focus is on identifying and treating the root cause of migraine and headache conditions, offering a medication-free pathway to lasting relief. Here’s what you need to know about Botox for migraines, and why it may not be the long-term solution you’re looking for.
How Botox Treatment for Migraines Works
Botox treatment for migraine headaches is usually administered as a series of targeted Botox injections. Patients who receive Botox do so under a defined protocol that focuses on specific muscles of the head and neck. While evidence shows that Botox works to reduce headache days in people with chronic migraine, it has not shown the same benefit for those with episodic migraine. Understanding how and where Botox is injected helps explain both its potential benefits and its limitations.
Administration & Injection Sites
Botox is a botulinum toxin type A, a purified neurotoxin complex. For migraine prevention, patients typically receive Botox injections from a small needle at 31 sites across 7 muscle areas every 12 weeks. These injection sites include the corrugator, procerus, frontalis, temporalis, occipitalis, cervical paraspinal, and trapezius muscles. Common effective injection sites include the forehead, temples, back of the head, neck, and shoulders, which together make up the areas most often targeted in clinical treatment.
Treatment Theory
It works by blocking the release of pain-related neurotransmitters from nerve endings, dampening activation of pain networks. Clinical trials show Botox reduces the number of monthly migraine days by about 2 days more than a placebo. Importantly, Botox does not treat the underlying mechanisms driving migraines.
Botox for Migraines – Side Effects You Should Know
The Most Common Side Effects of Botox Injections
- Neck pain
- Muscular weakness or stiffness
- Eyelid drooping (ptosis)
- Injection-site pain
- Headache worsening shortly after treatment (in a small number of patients)
Long-Term Side Effects of Botox for Migraines
- Repeated cycles have shown no new long-term safety concerns in clinical studies up to 5 years.
- Some patients discontinue treatment due to an inadequate response or side effects.
- Changes in facial appearance, such as drooping eyelids or a “frozen” look, may occur when facial muscles are affected.
Rare But Serious Risks
Botox carries a boxed warning for possible spread of toxin effect, which can cause swallowing or breathing difficulties. These are rare but serious side effects.
Special Considerations
- Safety in pregnancy and breastfeeding has not been established, as trials excluded these groups. Decisions should be made with a treating physician.
- Not all adults with migraine are suitable candidates for Botox.
Does Botox Fix the Root Cause of Migraines?
The short answer is no. Botox reduces the severity of migraine symptoms by dampening pain signalling, but it does not address the underlying dysfunction in the cervical spine and brainstem that research links to migraine development. Once treatment is stopped, migraine attacks usually return.
This makes Botox similar to other preventative medications. It helps manage frequency, but does not correct the cause.
Should You Try Botox for Migraines?
For some patients with chronic migraine, Botox can reduce headache days. However, it requires ongoing injections every 12 weeks, can be costly, and carries risks of side effects. Most importantly, Botox does not resolve the root cause of migraines.
It often takes more than the first treatment to know whether Botox will make a difference, as results are usually assessed over several cycles. If you’ve tried Botox, other injections, or preventative medications with limited success, it may be time to consider an alternative.
A Different Approach – Long-Term Relief Without Medication
At Gold Coast Headache & Migraine Clinic™, we take a different path. Our migraine treatment focuses on assessing and correcting dysfunction in the upper cervical spine and desensitising a sensitised brainstem. These factors are strongly associated with chronic migraine conditions.
Our approach is:
- Safe & Gentle – no aggressive manipulation, medication, or injections.
- Medicine-Free – helping patients move away from reliance on drugs.
- Effective & Lasting – for suitable patients, we expect improvements within 6 sessions.
At our clinic, your clinician will design a personalised treatment plan that targets the root cause of your migraine headaches, rather than masking symptoms with ongoing injections.
Begin Your Journey to Lasting Migraine Relief
At Gold Coast Headache & Migraine Clinic™, we focus on helping patients achieve long-term results by treating the underlying drivers of migraine. Book an initial consultation today to find out if our safe, medication-free approach is right for you. Imagine living a life free from migraines and saying goodbye to headache medicine.
Book your assessment today with Gold Coast Headache & Migraine Clinic™.
Botox for Migraines – FAQs
Does Botox for migraines change your face?
Yes. Botox can cause drooping eyelids or temporary changes in facial muscle activity, sometimes leading to a stiff or “frozen” look.
What are the long-term side effects of Botox for migraines?
Long-term studies show no new safety concerns, but patients may experience neck weakness, eyelid drooping, or decide to stop due to limited benefit.
How long does Botox for migraines last?
The effects last about 12 weeks, so repeat treatments are required every three months.
Is Botox for migraines safe during pregnancy?
The safety of Botox during pregnancy and breastfeeding is not well established. Always discuss with your doctor if you are pregnant, planning pregnancy, or breastfeeding.
References
Dodick DW, Turkel CC, DeGryse RE, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomised, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50(6):921-936. doi:10.1111/j.1526-4610.2010.01678.x
Aurora SK, Dodick DW, Turkel CC, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the PREEMPT 1 trial. Cephalalgia. 2010;30(7):793-803. doi:10.1177/0333102410364676
Diener HC, Dodick DW, Aurora SK, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the PREEMPT 2 trial. Cephalalgia. 2010;30(7):804-814. doi:10.1177/0333102410364677
Jackson JL, Kuriyama A, Hayashino Y. Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults. Cochrane Database of Systematic Reviews. 2012;(8):CD004611. doi:10.1002/14651858.CD004611.pub3
Blumenfeld AM, Stark RJ, Freeman MC, et al. Long-term safety and efficacy of onabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. Headache. 2018;58(10):1610-1623. doi:10.1111/head.13431
Cernuda-Morollón E, Ramón C, Larrosa D, et al. Long-term experience with onabotulinumtoxinA in chronic migraine: efficacy, safety, and tolerability. Cephalalgia. 2015;35(7):545-553. doi:10.1177/0333102414547785
Ailani J, Blumenfeld AM. OnabotulinumtoxinA for the treatment of chronic migraine: insights from clinical practice. Headache. 2021;61(8):1161-1175. doi:10.1111/head.14171
Therapeutic Goods Administration (TGA). Australian Product Information: BOTOX® (onabotulinumtoxinA). Canberra: Department of Health, updated 2023. Available from: https://www.ebs.tga.gov.au/
International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202
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