Botox for migraines is now an FDA approved treatment for chronic migraines. Does that give you hope? It should. People who suffer from chronic migraines feel like they are driving without a steering wheel. They feel out of control. Their life can become consumed with anxiety for their next bout with migraine pain. That feeling is not only incredibly frustrating. It’s disappointing.

Here are the hard facts: A 2015 study showed that the prevalence of chronic migraines was nearly 1%. Migraine sufferers were more commonly female, in mid-life, and in households with the lowest annual income.

In this article, we’ll discuss how does botox for migraines work, what to expect, how much botox for migraines costs, and why there’s often more to treating migraines or headaches than just botox or any medication for that matter. Let’s talk about migraines, possible solutions, and getting you the relief you deserve.

Intro to Botox for Migraines

Okay so truth be told, I’m a reconstructive dentist specialized in TMJ disorders, or if you want to be fancy, temporomandibular joint disorder. I say that to create context. The point is I am unbiased. I have no stake in botox. Everything in this article is based on current research, my real-world experience, and my training treating patients with the most complex head and neck pain disorders in the country.


A large portion of my work is focused on problems of jaw function, but I had to also become an expert in headaches and migraines. The two conditions go hand in hand. We’ll discuss more on that later.

What Causes Migraines?

what causes migraines and how botox for migraines works

I began this article with a bold visual. I compared suffering from migraines to driving without a steering wheel. The answer to “what causes migraines” is what creates this feeling. At this point, there’s a significant amount of debate about the cause of migraines. It’s frustrating, I know, but it’s the best we have with the current research.

Pending more investigation, most studies show that blood vessels constrict during migraines. The constriction occurs for an unknown reason, but there have been several triggers identified. Multiple triggers may include Alcohol, certain foods, dehydration, weather, fatigue, light sources, genetics, and stress.

Okay so migraines are caused by constriction of blood vessels and that causes pain right? Well, not exactly.

The studies also show that there is increase in serotonin during migraines. It’s believed that serotonin further causes constriction of the blood vessels to the point where there is a rebound reaction.

Now here’s where things get really interesting. The body senses there is inadequate blood flow in the area of the head. So what does it do? It excessively widens the blood vessels and blood rushes to the area. That’s what causes the sensation of a migraine.

The excessive blood flow to the head causes a throbbing sensation according to research. It creates pressure, tenderness, and inflammation. In my opinion, there’s more to the story, but for now this is all the research shows.

What is Botox

Botox is a form of botulinum toxin. When people hear the term botox, they usually think one of two things: 1) Isn’t that for wrinkles? and 2) Gosh, I don’t want a toxin in my body. Both are valid thoughts. Yes, it is also used to help reduce wrinkles, and yes, it is technically a toxin, but botox exceptionally safe when used for these FDA cleared purposes.

Botox is a neurotoxin produced by the bacteria that causes botulism. When the Botox botulinum toxin is purified and used in tiny doses in specific areas, it temporarily reduces muscle contractions for approximately 3-6 months. The botox remains only locally and does not disperse throughout the entire body.

When botox reduces muscle contraction, it allows the skin to relax, hence the reduction of fine wrinkles, but more importantly, it also reduces muscle contraction and tension, which occurs in conjunction with headaches and migraines.

How Does Botox Work?

how botox for headaches and botox for migraines works neurotransmitter illustration

Botox is injected into the muscles of the head and neck. There are several muscles that connect to the head that are involved in headaches. Botox attaches to the nerve endings where it is injected, and it serves only one function. Botox blocks the release of chemicals involved in muscle contraction. This prevents the activation of pain sensation in the brain associated with muscle tension, tenderness, and inflammation. New findings also indicate that botox reduces the release of neurotransmitters that cause migraine pain.

The result of botox treatment is the reduction of the number of migraine or headache days by an average of 50% which lasts for 3 to 6 months. As you can see, there is a little bit of disconnect on why this helps. Research supports that migraines are vascular-related, but treatment supports that migraines are muscular related. The general concept you need to understand is that vasculature of the muscles of the head and specifically the tension in those muscles is generally what botox for migraines targets.

Botox for Migraines What to Expect

The procedure to treat headaches and migraines with botox is simple. The doctor examines your head and neck and identifies areas where the muscles are most likely contributing to your migraines. The target areas are probably already familiar to you. If you get migraines on the sides of your head or in the forehead, you’ll be having those areas treated.

The doctor will swab the area with rubbing alcohol to disinfect the skin and mark the areas of muscle tension. The botox is then administered with a small needle, and when I say small, I mean tiny. It’s a 30 gauge need. To give you an idea, think like a mosquito. The botox is typically administered in one appointment. The injections take about 10 minutes to go through the series of injection areas.

How Long Does it Take for Botox to Work for Headaches

Botox has delayed action. The effects of botox may begin in 72 hours; however, the majority of people will not see the full results for 10-14 days.

In the case of treating migraines with botox, however, there’s even more to consider.

Studies indicate that botox works for migraines over a series of treatments. Patients who received three cycles of Botox for migraine showed that their headache symptoms, and more importantly, their quality of life, continued to improve with treatment. Here’s the good news: Approximately 65% of patients with chronic migraines responded successfully to Botox after 3 courses of treatment.

And I’ll reiterate one more time in a more concise way. In a recent study of chronic migraine suffers treated with botox this is what was found:

  • 81 percent reported less frequent and/or less intense head pain
  • 61 percent reported excellent pain relief
  • 20 percent reported some pain relief.

Where do They Inject Botox for Migraines

There are a few varying philosophies for which locations to use botox for migraines. Much of the decision of where to inject botox for migraines is patient specific.

A doctor usually determines where to inject based on the patient’s pain history and trigger points. However, studies indicate that all injection philosophies suggest an injection of at least 6 main muscle areas: the procerus, the corrugators, the frontalis, the temporalis, the occipitalis and posterior cervical areas. Check here for an interactive illustration of the anatomy.

How Much Does Botox Cost

how much does botox for migraines cost

If you are considering the treatment of botox for migraines, you’re probably wondering how much does botox cost. Botox for migraines is billed by the number of units used. You’ll hear the term units used often with Botox. Don’t ask me why the manufacturer doesn’t use milligrams like everyone else. It’s just “units.” Typically a migraine sufferer will require 50 to 100 units of botox per treatment.

As a ballpark, you can expect botox for migraines to cost in the range of $1000 to $1800. The cost of botox varies depending on the severity of your case and the geographic area.

Because botox for migraines is now FDA approved, some medical insurances may cover some or all of the cost. So you may contact your medical insurance to see if you have medical insurance benefits that can be applied to help with the cost.

Why there’s more to it: Migraines and Temporomandibular joint disorder

tmj disorder and migraines

As you can probably tell by this point, the theme with migraine research is that we need to know more than we currently do. I find that people who suffer from migraines— suffer for a long time. Even with medication, some still hurt. Something doesn’t add up in those circumstances. People shouldn’t be suffering when they are taking numerous medications for migraines.

My advice to you is don’t lose faith and keep searching for a better solution. Maybe its botox for migraines, and maybe its not for your particular case. The point is there will be a treatment that works best for you. Don’t lose hope in researching possible solutions.

In my practice, we treat patients with severe TMJ disorder, some of the most severe in the country to be exact. Do you know what they also usually have when I first meet them? Migraines and headaches. That’s not a coincidence.

Here’s the reason why: The muscles of the jaw and TMJ are connected to the head. If the patient has strain from their jaw, from their neck, or from their posture— there’s a good chance they’ll will be susceptible to headaches.

The point is if you have been trying a particular treatment for migraines and it’s not working, talk with your doctor to test another option. Have your jaw evaluated as a possible source. Review your posture throughout the day. Explore if botox can treat the muscles. And have your neck and spine checked to see if there is an orthopedic or neurologic component.

It is my hope that no one suffers from chronic migraines for longer than they need to. There’s a solution out there. I hope you find what works best for you.