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

Can Botox injections treat migraines?

Yes, Botox injections can be used to treat migraines, but it’s not clear how Botox works for this purpose. One theory is the medication may help block some of the pain signals in the nerves that cause migraines.

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

Botulism toxin can be deadly. But when it’s refined for commercial use, it’s safe and works to treat 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

• Chronic anal fissures and anal sphincter muscle spasms

• Abnormal neck contraction (cervical dystonia)

• Treatment and prevention of wrinkles

Where is Botox for migraines injected?

Unlike other migraine treatments, Botox is given as a series of small injections directly into the forehead muscle.

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.

What are common side effects of Botox for migraines?

There are very few side effects that can occur 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.

Other Botox side effects can include:

• Neck pain

• Muscle weakness

• Swelling and/or bruising at the injection site

• Dry skin, dry mouth, or dry eyes

• Eye problems like blurry vision or double vision

• Droopy eyelids

• Upper respiratory tract infection

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

How much does it cost to get Botox 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.

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, you may need to take some additional steps to get covered. 

Can Botox injections be used for other headaches?

Maybe. Some studies show that Botox can help treat other types of headaches, like tension-type headaches. But in other studies, Botox wasn’t 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. 

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 won’t cure your chronic migraines. Most people need at least four Botox treatments per year to keep their chronic migraines under control. 

How often is Botox needed to prevent migraines?

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 Botox, based on how you respond to treatment. And they may recommend that you keep taking other migraine medications until you see an improvement.

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)

• Calcitonin gene-related peptide (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 studies, people who received Botox had 2 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.

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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:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Farzon A. Nahvi, MD

Farzon Nahvi, MD, is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works at Concord Hospital in Concord, New Hampshire, and teaches at the Geisel School of Medicine at Dartmouth.

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