Botox for migraine

A National Migraine Centre factsheet

Not just for wrinkles: Botox could help you reduce the impact of chronic migraine

This factsheet was produced by headache doctors and brings together the latest trusted advice and information on Botox treatment for migraine.

Available as a series of injections, Botox treatment seeks to prevent headaches for those with chronic migraine, with most people affected seeing improvement after treatment.

The National Migraine Centre provides access to expert clinicians who can provide Botox treatment for migraine in the UK. You can find out more and book an appointment here.

What is Botox?

Botox is a brand of botulinum toxin. There are other brands, but these have not been proved helpful in any form of migraine or headache.

The toxin comes from a bacterium called clostridium botulinum. The way it is taken from the bacterium and prepared varies between the different manufacturers, so different brands of botulinum toxin may work differently.

Isn’t Botox a treatment for wrinkles?

Botulinum toxin gets into nerve endings and stops the nerve being able to respond normally to an electrical nerve impulse. So, when facial expression muscles are injected, facial wrinkles are reduced.

It was noticed by chance that people having cosmetic botulinum toxin injections tended to have fewer headaches. Research then went on to prove that Botox could help people with chronic migraine.

Botox for migraine

Botox is licensed for the treatment of chronic migraine, which is defined as three months or more of at least 15 days of headache a month, of which at least eight days have features of migraine (such as nausea, light or noise sensitivity, pulsating or lateralised pain).

The National Migraine Centre can connect you with expert headache specialists who can help you determine whether or not you might benefit.

How does Botox work in migraine?

It is thought that the botulinum toxin gets into the small nerves that carry pain from the head to the brain, known as C-fibres. This reduces the amount of chemicals released from the nerve ending, reducing migraine and headache.

How is Botox given?

Botox is given as a series of 31 to 39 tiny (0.1ml) injections under the skin or into the muscles in and around the head or the forehead, above the ears, and into the neck and shoulders.

The injections are repeated every 12 weeks until the patient no longer has chronic migraine, or until it is clear that treatment is not working.

Normally, those patients who benefit will see an improvement after the first or second set of injections. About one in ten people respond to a third set of injections if the first two sets fail.

How effective is Botox for people with migraine

The goal is not to become completely free of headache or migraine but to improve quality of life, and to convert migraine from a chronic condition to an episodic one.


  • 25 per cent of patients will see a good response to the first or second set of injections
  • 50 per cent see some improvement after one or two sets of injections, but need further to get a good response
  • 25 per cent do not see any improvement

How long does Botox take to work for migraine?

The biological effect of botulinum toxin on nerves takes several days, or even a few weeks, to work. You should not expect chronic migraine to improve significantly in less than four weeks.

Who can’t have Botox for migraine?

Botox is only suitable for people with chronic migraine. It’s also not suitable for you if you are pregnant or breastfeeding.

You have an increased risk of side effects if you suffer from another neurological disease (such as Bell’s palsy, a neuropathy, or myasthenia gravis) or if you have had cosmetic botulinum toxin injections in the past three months.

Tell your doctor if you:

  • have had problems with injections (eg fainting) in the past
  • have had problems with previous botulinum toxin injections
  • have inflammation, weakness or wasting of the muscles/skin where your doctor plans to inject
  • have had problems with swallowing, or food or liquid accidentally going into your lungs, especially if you will be treated for persistent muscle spasms in the neck and shoulders
  • suffer from any other muscle problems or chronic diseases affecting your muscles
  • suffer from certain diseases affecting your nervous system
  • have an eye disease called closed-angle glaucoma or were told you were at risk of developing this type of glaucoma
  • have had any surgery that may have changed the muscle that is being injected
  • will have an operation soon
  • are taking any blood thinning medicine

What side effects might I get?

The injections are slightly prickly or stingy and take about five minutes to complete.

It is possible, though rare, to have an acute allergic response, so you should stay in the clinic for several minutes after the first set of injections.

Fewer than one in ten patients experience one or more of the following side effects:

  • Worsening migraine. This can begin within a day or two of the injections and usually lasts just a few days.
  • Headaches can usually be treated with triptans and/or regular naproxen (250mg or 375mg) three times daily after meals. Always speak to a headache specialist before beginning a new treatment.
  • Rash, itching
  • As with all injections, you may experience localised pain, bruising, bleeding or infection
  • Drooping of eyebrows or eye lids. This can begin after a couple of weeks and may last for a few weeks.
  • Muscle weakness, pain, cramp or tightness
  • Weakness and pain in the neck. This can begin after a couple of weeks and may last for a few weeks. It can usually be treated with regular naproxen (see above).

Less than one person in 100 may experience:

  • Difficulty in swallowing
  • Skin pain
  • Jaw pain
  • Swollen eyelid(s)

Contact a doctor immediately or visit your accident and emergency department if you have any of the following after Botox treatment:

  • difficulty in breathing, swallowing or speaking
  • hives or swelling, including to the face or throat
  • wheezing, feeling faint or shortness of breath
  • any other suspected side effects that you feel could be as a result of Botox treatment

Most people have no, or relatively minor, side effects. This is not a full list of side effects and you should discuss with a headache specialist before proceeding.

How to get Botox treatment for migraine

At the National Migraine Centre, we can provide you with quick and easy access to a clinician who is able to discuss with you Botox treatment.

You can find out more about Botox pricing here or go ahead and request an appointment here.

Listen to our Heads Up podcast episode 4 in series 2 for more information on Botox for migraine.

Speak to a leading GP headache specialist or consultant neurologist remotely, from the comfort of your home.

The National Migraine Centre has helped thousands of people like you to take control of headache. Get expert advice with specialist consultations, access the latest treatments and anti-CGRP medications, and book procedures such as Botox and nerve block.

Get back to living: book a consultation today

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