Botox injections for migraine

About Botox

Botox (botulinum toxin type A) is a type of medicine known as a nerve toxin. It comes from the bacterium Clostridium botulinum. Botox is injected into muscles, causing them to relax.

Botox is used to treat lots of conditions. These include cerebral palsy, overactive bladder, muscle spasms, excessive sweating and stroke-related disability. It’s also used as a cosmetic treatment to smooth out wrinkles and lines on the face.

Botox can also be helpful in the treatment of migraine. Botox for migraine is given in a different way to Botox for cosmetic treatment. It’s important to only get Botox for migraine through referral to a trained specialist. We have more information on this in the next section.

It’s not clear exactly how Botox works for migraine. But scientists think it blocks chemicals called neurotransmitters being released from nerves. The neurotransmitters are involved in carrying pain signals. Blocking them may prevent the pain you get in migraine.

Who can have Botox for migraine

Botox is approved on the NHS in the UK for the treatment of chronic migraine in adults. Chronic migraine means you have at least 15 headache days a month, with migraine symptoms on at least eight of these. It’s not licensed for episodic migraine or other types of headache, such as tension and cluster headache. Episodic migraine is when you have headache on fewer than 15 days a month.

Botox for migraine is only available via a headache specialist or consultant neurologist. Your GP will need to refer you. The specialist will assess your history and symptoms and discuss your treatment options. These may include medicines such as calcitonin gene-related peptide (CGRP) monoclonal antibodies and gepants, as well as Botox.

To be offered treatment with Botox, your doctor will want to make sure:

• you have tried at least three other preventive treatments, which haven’t helped
• you are not taking acute medicines too frequently, which can cause medication overuse headache.

It’s important that you only get Botox treatment for migraine from a specialist with the appropriate training. Botox for cosmetic treatment is given at different doses and in different areas to Botox for migraine.

What Botox injections for migraine involve

You will have an appointment for your Botox treatment at a clinic in hospital. Botox treatment for migraine involves a series of between 31 and 39 small injections. You have these around your forehead, above your ears, on the back of your head, and along your neck and shoulders.

The injections are done in these areas as they align with major nerves in your head, which are thought to be involved with migraine. Botox injections at these sites have been found to be effective for preventing migraine.

The effects of Botox wear off over time. You will usually be able to have the injections every 12 weeks.

We have more information on what to expect from Botox treatment.

How well Botox works for migraine

Botox can reduce how often you have migraine attacks and how severe they are. For many people, it reduces the number of headaches they have by 30-50%. This means if you were having 20 headache days a month, you may have 10 to 14 after treatment with Botox.

Botox can also improve how people feel about their quality of life, even if they don’t have a big reduction in headache days.

Monitoring treatment

You should be asked to keep a headache diary to monitor how well the treatment works for you. Most people have at least two treatment cycles before deciding if Botox is working for them. If it’s helping, you can usually carry on taking it until your migraine has changed from chronic to episodic for three months in a row. Episodic means you have fewer than 15 headache days a month.

Botox doesn’t work for everyone. If it’s not helping, talk to your specialist about other treatment options you can try. These may include other types of preventive treatment. Your doctor may also suggest a combination of treatments.

Side effects of Botox

The most common side effects of Botox treatment include:

• neck pain
• muscle pain, stiffness and weakness
• rash and pain at the injection site
• drooping of the eyelid.

Some people notice their migraine attacks get worse at first.

These side effects are usually temporary and happen in the first few days after treatment. If you have any concerns, contact the clinic where you had your treatment, your GP or NHS 111.

Who should not have Botox for migraine

There is not much data about the use of Botox for migraine during pregnancy. Because of this, doctors will not usually recommend using it during pregnancy, unless the benefits outweigh the risk. Sometimes it may be the best option if you need migraine treatment during pregnancy. Tell your doctor if you are pregnant before trying Botox.

We have more information on migraine in pregnancy.

About our information

This information has been written by The Migraine Trust Information and Support Services team. It has been reviewed by our panel of expert health professionals and people affected by migraine.

Our information has been awarded the PIF TICK quality mark for trustworthy health information.

If you have feedback on our information, please get in touch at: feedback@migrainetrust.org

References for our information are available on request.

Last reviewed: February 2025 | Next review due: February 2028