Last Updated on June 14, 2026
Botox is one of the most effective preventive treatments available for chronic migraine — 15 or more headache days a month. It is given as a set of small injections across the head and neck, takes about 8 minutes, and is funded under the PBS for people who qualify.
Having personally treated many hundreds of patients with Botox for migraine over the years, this page explains who it helps, exactly where the injections go, what it feels like, the side effects, and how a tailored “follow-the-pain” technique can improve results. For chronic migraine more broadly, see our headache & migraine overview; for the newer CGRP medications, see CGRP therapies at our Sydney Headache Centre.
Who is Botox for migraine for?
Botox is approved and PBS-funded for chronic migraine only — defined as 15 or more headache days per month, of which at least 8 are migraine days. It is not used for occasional or episodic migraine.
To qualify under the PBS you need a headache diary documenting the required number of days, and you must have already tried at least three preventive medications without enough benefit. Treatment is given as two initial courses, and can only continue if your headache frequency roughly halves.
In other words, this is for people with a high burden of headache, and it is continued only when it produces a meaningful reduction. That may sound like a small group, but chronic migraine affects 1–2% of the world’s adults — it is far more common, and far more under-treated, than most people realise.
Take our Migraine Botox quiz to see if you might qualify →
Where do the injections go? The PREEMPT protocol
Botox for migraine is injected using the PREEMPT protocol, the method validated in the clinical trials that proved Botox works in chronic migraine. The standard treatment is 31 injections across seven muscle groups of the head and neck — forehead, temples, back of the head and the neck and shoulders. These cover the common trigger points of migraine. There is a brief sting with each injection, but it is usually very manageable.
The whole session typically takes about 8 minutes, and most patients finish saying it was nowhere near as uncomfortable as they had expected.
The “follow-the-pain” approach — tailored to your pain
The standard injection pattern is the starting point, not the whole story. The PREEMPT protocol also allows additional injections beyond the standard sites, placed wherever a person’s pain is most concentrated. This is known as the “follow-the-pain” approach, and it is evidence-based: it was built into the original trials and is recognised in the way Botox is meant to be delivered.
In my experience this tailoring matters. Rather than treating every patient with an identical map, I add extra injections at the specific areas driving each person’s headaches — and, where appropriate, at higher doses in those areas. Matching the treatment to your own pain pattern, rather than a one-size-fits-all template, can meaningfully improve how well it works.
The result is a treatment shaped around your headache — where it sits, how it behaves, and what has and hasn’t helped before.
Are there side effects?
In general there are few. Most people feel some local soreness for a day or two that then settles. Temporary neck pain is reported in about 4% and a brief worsening of migraine in about 4%; a rash or itch at the injection site occurs in under 1%. There is a very rare risk of short-lived drooping of an eyelid — in my own practice I have seen this once, and only for a few days.
Each treatment lasts about 10–12 weeks, and can be repeated every 12 weeks.
For most people the side effects amount to a little soreness for a day or two — and serious problems are genuinely uncommon.
Does it work?
In my experience, yes — though, like any treatment, not for everyone. The response rates are very good, at least as good as the other medications used to prevent headache. In data collected after the clinical trials, 65% of patients receiving Botox for the first time were satisfied or very satisfied with the treatment (Congress of European Neurology, 2017, abstract 04108).
In the clinical trials of Botox, 40–50% of patients had a greater than 50% reduction in the number of headache days per month.
When compared head-to-head with other preventive medications such as topiramate, valproate and amitriptyline, the effects were similar — but Botox avoids the daily-tablet burden and many of their day-to-day side effects.
How does Botox work in migraine?
The mechanism is still being worked out, but the popular idea that it simply “relaxes muscles” is almost certainly wrong — Botox has been shown to work even when there is no muscle relaxation.
The most likely mechanism is that the toxin is taken up into nerve endings and blocks the release of CGRP — the neurotransmitter most responsible for the inflammation around the covering of the brain that drives migraine. That is the very same target as the newer CGRP migraine preventives: Emgality, Ajovy and Vyepti (PBS-listed for chronic migraine) and Aimovig. Dr Granot has extensive experience with both Botox and these CGRP therapies, and can help you decide which approach — or combination — suits you best.
Frequently asked questions
Where do they inject Botox for migraines?
Botox is injected at 31 points across the forehead, temples, back of the head and the neck and shoulders, following the PREEMPT protocol, with extra “follow-the-pain” injections added where your pain is concentrated.
What are the side effects of Botox for migraine?
Most people have only brief local soreness for a day or two. Temporary neck pain (about 4%) and, rarely, short-lived drooping of an eyelid can occur. Serious side effects are uncommon.
Who qualifies for Botox for migraine?
It is PBS-funded for chronic migraine — 15 or more headache days a month — in people who have already tried at least three preventive medications. It is continued only if headache days roughly halve.
Does it hurt, and how long does it take?
There is a brief sting with each injection, but the whole session takes about 8 minutes and most people find it far easier than they expected.
How long does Botox for migraine last?
Each treatment lasts about 10–12 weeks and can be repeated every 12 weeks.
Considering Botox for migraine?
Dr Ron Granot has treated many hundreds of patients with Botox for chronic migraine at East Neurology, Bondi Junction. Ask your GP for a referral, then get in touch — we’ll help with the rest.
Or call 02 9388 0615. East Neurology is a private specialist practice focused on expert diagnosis and prompt results; your Medicare rebate is processed for you on the day.
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