Botox® for Chronic Migraine
An effective treatment option for patients living with frequent headaches
Botox® has been approved for the treatment of chronic migraine since 2010. Dr. Barsoom has over 16 years of experience using Botox® as a safe and effective therapy for patients with migraine, in addition to its well-established use for conditions such as muscle spasticity, excessive sweating (hyperhidrosis), and dystonia.
Schedule a consultation to see if Botox® therapy is right for you.
What is Botox®?
Botox® is a purified protein derived from Clostridium botulinum. For decades, it has been used safely in medicine to treat:
• Eye conditions such as strabismus (crossed eyes)
• Muscle spasticity
• Excessive sweating (hyperhidrosis)
• Overactive bladder
• Abnormal muscle contractions (dystonia)
• Blepharospasm (excessive blinking)
• Chronic migraine
Botox® is also widely used in cosmetic medicine to smooth wrinkles. For migraine treatment, very fine needles are used to inject Botox® into specific muscles of the face, neck, and upper back.
How Does Botox® Work for Migraine?
• Nerves communicate with muscles, glands, and sensory organs by releasing chemical messengers. These messengers can trigger muscle contraction, sweat production, and pain signals.
• Botox® blocks the release of these chemical messengers. This reduces muscle contractions, stops sweat production, and most importantly for migraine, decreases nerve activity that contributes to pain.
• In chronic migraine, sensory nerves become inflamed and hypersensitive. Botox® “calms” these overactive nerves, lowering the release of pain-causing molecules and reducing abnormal electrical activity in the brain’s pain networks.
Health Canada approved Botox® for the treatment of chronic migraine in 2011 after large clinical trials demonstrated its safety and effectiveness.
How is Botox® Given for Migraine?
Botox® for migraine is administered using a standardized treatment approach known as the PREEMPT protocol (Phase III Research Evaluating Migraine Prophylaxis Therapy). This protocol was developed through large clinical studies and is widely used by headache specialists around the world.
During treatment, small amounts of Botox® are injected into specific muscles of the forehead, temples, back of the head, neck, and upper shoulders that are involved in migraine pain pathways. The treatment typically involves 31 small injections across several muscle groups.
These injections are performed approximately every 12 weeks. The goal is to reduce the frequency and severity of migraine attacks by calming the overactive pain signaling around the head and neck.
Accurate placement of injections is important for achieving the best results while minimizing possible side effects such as temporary neck discomfort or muscle weakness.
Standard Injection Sites for the Botox® PREEMPT Migraine Protocol
Who is Botox® for?
Botox® is approved for chronic migraine, defined as:
• 15 or more headache days per month, for at least 3 months
• At least 8 of those days must have migraine features (e.g., throbbing pain, nausea, sensitivity to light/sound)
Benefits of Botox® for Migraine
The main goal is to reduce both the frequency and severity of headaches. Results may vary, but studies show:
• Many patients achieve over 50% improvement in migraine frequency and intensity
• About 23% of patients are “super-responders,” improving by 75% or more
• Benefits are often sustained with continued treatment
Other improvements may include:
• Less severe migraine attacks
• Headaches that respond better to acute medications
• Reduced baseline headache or neck pain
• Greater tolerance to migraine triggers
• Improved overall functioning and quality of life
How Long Does It Take to See Results?
• A trial of three treatment cycles (about 9 months) is recommended.
• Some patients notice improvement after the first cycle, while others may not improve until the third.
• The effect is often cumulative, with results building over time.
Next Steps
Botox® is not suitable for every patient, but it can be life-changing for those with chronic migraine.
Ask Dr. Barsoom whether Botox® could be an option for your migraines, especially if other treatments have not provided relief.
For more detailed information, visit Migraine Canada – Botox for Migraines.
References
Frampton JE, Silberstein S. OnabotulinumtoxinA: A Review in the Prevention of Chronic Migraine.
Drugs.2018;78(5):589-600.
Ashkenazi A, Blumenfeld A. OnabotulinumtoxinA for the treatment of headache. Headache. 2013;53 Suppl 2:54-61.
Dodick DW, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50(6):921-36.