What Are the Costs and Side Effects of Botox for Migraines?

If you’ve ever had a migraine, you know that it’s more than just a headache. The throbbing head pain can be associated with nausea, vomiting, and sensitivity to light. For many people, migraine symptoms are so severe that they can interfere with normal life.

Fortunately, there are different treatments for migraines. Botox is one you may have heard about. Here, we’ll talk about how Botox works for migraines and if it’s a good treatment option for you.

How do Botox injections help treat migraines?

It’s not clear how Botox works to prevent migraines. One theory is the medication may help block some of the pain signals in the nerves that cause migraines.

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Botox contains a compound called onabotulinumtoxinA. This compound is naturally produced by the bacteria Clostridium botulinum, which is found in soil. It’s a neurotoxin, which means it blocks nerve activity. This includes blocking pain signals and signals for muscle movement, which temporarily paralyzes muscles. 

Botulism toxin can be deadly in nature. But when it’s refined for commercial use, it’s a safe and effective treatment for several conditions, including:

• Chronic migraines

• Overactive sweating (hyperhidrosis)

• Crossed eyes (strabismus)

• Prolonged eye twitching (blepharospasm)

• Stiffness and/or spasms (spasticity) in the arms or legs

• Abnormal neck contraction (cervical dystonia)

• Treatment and prevention of wrinkles 

What are Botox for migraine treatments like?

Unlike other migraine treatments, Botox is given as a series of small injections directly into the forehead muscle. In a single treatment session, between 30 and 40 shots are given throughout seven different parts of the forehead, head (side and back), and neck (upper and lower). Each treatment cycle can take about 10 to 20 minutes. It’s important that the correct sites are treated, or else the treatment may not be as effective.

It’s recommended that a treatment cycle be given every 3 months to help manage migraine attacks. Your prescriber will work with you to see how long you need to continue the Botox based on how you respond to treatment. And they may recommend that you keep taking other migraine medications until you see an improvement.

What are common side effects of Botox for migraines?

There are very few side effects associated with Botox treatments. The needle used is very small. While some people may feel a small pinch with the injection, many don’t feel anything.

EXPERT PICKS: WHAT TO READ NEXT

• Curious about trying Botox? Here are some common side effects that you should know about. 

• Want to prevent your migraines from occurring so often? This list of treatments may have an option to help reduce the number of migraines you have.

• Got chronic migraines? These evidence-based treatments help to prevent and treat breakthrough migraines.

Other Botox side effects can include:

• Neck pain

• Muscle weakness

• Swelling and/or bruising at the injection site

• Dry skin

Rarely, people can experience eyelid drooping, vision changes, or muscle weakness in areas further away from the injection site.

How many units of Botox do you need for migraines?

For chronic migraines, the FDA recommends using 155 units of Botox per treatment. This can cost between $300 and $600. There’s a “Botox savings card,” which can help defer some of these costs if your insurance doesn’t cover Botox treatment. 

Where do you inject Botox for migraines?

When Botox is used to treat migraines, it’s usually injected into the:

• Forehead and scalp

• Bridge of the nose

• Temples

• Back of the head and neck 

Keep in mind that the exact injection spots may vary from person to person. A healthcare professional will pick locations depending on your anatomy and where you have pain points.

Can you get Botox for headaches that aren’t migraines?

Maybe. There are some studies showing that Botox can help treat other types of headaches, like tension-type headaches. But in other studies, Botox was not helpful in preventing future episodes of chronic headaches. Right now, there’s no reliable evidence that Botox is helpful for treating or preventing other types of chronic headaches. So, while you may be able to access Botox treatment for headaches, there’s no guarantee the treatment will help. 

Another issue is cost. Botox is only FDA approved to treat chronic migraines. Botox for other types of headaches is considered off-label treatment. This means that your insurance company may not cover the cost of the medication or the visit to have Botox injections. Cost and uncertainty are the two main reasons Botox isn’t a commonly used treatment for other types of headaches. 

How long does a Botox injection for migraines last?

Botox injections usually last 10 to 12 weeks. After that, the toxin starts to wear off, and the nerve cells recover and can send pain signals once more. So, Botox will not cure your chronic migraines. Most people need at least four Botox treatments per year to keep their chronic migraines under control. 

Also, keep in mind that it can take a few weeks to see an effect from Botox, so you may not notice a change in your headaches right away. Also, while many people feel a difference after just one Botox treatment, it can take two or three treatments to get the maximum relief from Botox. 

When should you consider Botox for migraines?

For people who have tried other migraine treatments without success, or who have had side effects from those treatments, Botox may be a good option.

Most people turn to Botox treatments to stop chronic migraines when they don’t do well with other prevention treatments, like:

• Beta blockers, such as propranolol (Inderal)

• Antidepressants, such as amitriptyline (Elavil)

• Antiepileptics, such as topiramate (Topamax) or valproic acid (Depakene)

• CGRP antagonists, such as erenumab (Aimovig) or rimegepant (Nurtec ODT)

Many people with chronic migraines will respond well to one or more of these treatments. But for others, these medications may not work. That’s where Botox comes in. 

For this group, adding Botox to a chronic migraine treatment plan can give people more pain-free days and shorter headaches during migraine attacks. In one clinical trial, people who received Botox had two fewer migraine days per month than people in the placebo (control) group. The people who continued Botox treatment were still experiencing fewer headache days up to a year later.

Does insurance cover Botox injections for migraines?

Since Botox is an approved treatment for chronic migraines, many insurance companies will cover some — or all — of the costs. This includes both Medicare and Medicaid plans. 

That said, depending on your health plan, some further steps may be needed. More on this below.

Who is eligible to get Botox injections for migraines?

You may need to meet certain criteria to get Botox approved by your insurance company. This can include things like:

• History of chronic migraines (15 or more headaches each month for at least 3 months)

• Tried at least two other treatments without any improvement

To confirm this, they may ask that you work with a healthcare professional to submit a prior authorization form.

Like with any prescription medication, it’s important to work with your prescriber and insurance company. They can help you see what part of your treatment is covered and what you will be expected to pay out of pocket.

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Farzon A. Nahvi, MD

Dr. Nahvi is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works clinically at Concord Hospital in Concord, New Hampshire, and is a clinical assistant professor of emergency medicine at the Geisel School of Medicine at Dartmouth. Prior to this, he worked as an ER physician and clinical assistant professor of emergency medicine at the Mount Sinai Health System, NYU Langone Health, NYC Health + Hospitals/Bellevue, and the Manhattan VA. He is a graduate of Cornell University and NYU School of Medicine.

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