Botox (OnabotulinumtoxinA) for Chronic Migraine

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Botox (onabotulinumtoxinA) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to prevent headaches in adults with chronic migraine.

What Members Say

MHT logo These insights are based on 6,398 comments about Botox from MyMigraineTeam members. These are the experiences of a small number of individuals and are not meant to be medical advice.

Benefits:

Migraine days, intensity, and duration often decrease over time.
Treatment every 12 weeks can feel manageable when benefits last.
Benefit sometimes builds only after the second or third treatment.

Considerations:

Treatment requires multiple injections across the head and neck every 12 weeks.
Neck pain, injection-site pain, eyelid drooping, and muscle weakness can occur.
Relief can wear off before the next scheduled treatment.

How Botox Works and How It’s Taken

Botox is a type of nerve-blocking medicine that works by blocking the release of a chemical messenger called acetylcholine. In chronic migraine, this helps reduce pain-related nerve signaling.

Doctors prescribe Botox when an adult has chronic migraine, meaning headaches happen on 15 or more days each month and last four hours a day or longer.

Botox is given as intramuscular injections, typically every 12 weeks. These injections are given by a healthcare professional.

Typical Dosing for Chronic Migraine

The recommended dose of Botox for chronic migraine is 155 Units given by intramuscular injection, divided across 31 injection sites in seven specific head and neck muscle areas every 12 weeks. The injection sites are determined by your healthcare provider.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Botox

MHT logo These insights are based on 6,398 comments about Botox from MyMigraineTeam members.

Members who use Botox often say that setting realistic expectations, keeping up with regular appointments, and staying in close touch with a neurologist or headache specialist can make treatment easier to manage. Many also mention tracking patterns like wear-off timing, side effects, and migraine changes so they can discuss them with their doctor.

1

Be patient.
Improvement can take a few treatment cycles.

"My neurologist said that you typically don't see effect from Botox until the 2nd to 4th dose, and you taper up to your maximum needed dose within a year."
2

Keep Botox appointments on a regular 12-week schedule.
Staying on time may help treatment work more consistently.

"Keeping the shots in a timely manner is important. I missed my scheduled dose as the neurologist was sick and there was no back-up plan."
3

Track when Botox starts working and when it wears off.
Noting these patterns can help guide conversations with your doctor.

"The relief starts to wear off about a week before I am due for the next round."
4

Tell your doctor about side effects or injection problems.
Reporting concerns early may help your care team adjust treatment.

"I had to stop my Botox injections because I had experienced a left droopy eye."

Connect with others who understand life with chronic migraine. Join MyMigraineTeam for free.

Botox Side Effects

In clinical studies of Botox for the prevention of headaches in adults with chronic migraine, the most common side effects occurred in about 2 percent to 9 percent of people. They include:

Neck pain
Headache
Muscle or joint stiffness
Muscle weakness
Drooping eyelid
Migraine
Muscle pain
Muscle and bone pain
Bronchitis
Injection site pain
Facial weakness
Muscle spasms
High blood pressure

Serious Side Effects and Warnings

Botox can cause serious side effects that may require immediate medical attention. These include:

Spread of toxin effects — Effects may spread beyond the injection area and cause whole-body muscle weakness, double or blurred vision, drooping eyelids, trouble swallowing, trouble speaking, loss of bladder control, or breathing problems.
Swallowing, speaking, or breathing problems — These can be life-threatening.
Serious allergic reactions — These include anaphylaxis, which can cause hives, swelling, or trouble breathing.
Serious muscle weakness in people with certain nerve or muscle conditions — Individuals with neuromuscular disorders may be at higher risk of severe weakness, trouble swallowing, or breathing problems.

Get medical help right away if you think you are having a serious reaction.

How To Save on Botox

AbbVie, the manufacturer of Botox, offers the BOTOX Savings Program. Eligible commercially insured individuals may pay as little as $0. Individuals enrolled in Medicare, Medicaid, TRICARE, or any other government-reimbursed healthcare program are not eligible for this program.

To learn more, visit the BOTOX Savings Program website or call 800-44-BOTOX (800-442-6869).

What To Know Before Taking Botox

Tell your doctor if you have any allergies to onabotulinumtoxinA or any ingredients in Botox. Do not take Botox if you are allergic to any botulinum toxin product or to any of the components in the formulation.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Botox?

In two 24-week studies of adults with chronic migraine, people who received Botox had fewer headache days than those who received a placebo (an inactive treatment). This means Botox can help reduce how often headaches happen.

How long does Botox take to work for migraine?

Botox is given every 12 weeks to help prevent chronic migraine headaches. It may take some time to see improvement, but the exact time can be different for each person.

Can Botox cause neck pain or drooping eyelids when used for migraine?

Yes. In clinical trials for chronic migraine, neck pain was reported in 9 percent of people taking Botox, and eyelid drooping was reported in 4 percent.