Medical

Botox for chronic migraine

The FDA-approved PREEMPT protocol — for people living with 15 or more headache days a month.

This is the one thing on our menu that isn't cosmetic. Botox has been FDA-approved for the prevention of chronic migraine since 2010, and for the right patient it is genuinely life-changing — the pivotal trials showed roughly 8 to 9 fewer headache days per month compared with baseline.

It is also widely oversold. So here is the honest version.

It only works for chronic migraine

"Chronic" has a specific definition: 15 or more headache days per month, each lasting four hours or more, for at least three months. If you get migraines six times a month, this treatment is not indicated for you and the studies don't support it. We will decline rather than treat you outside the approved indication.

It takes two rounds to judge

Treatment repeats every 12 weeks, and benefit accumulates. One round is not a fair trial. Budget for about six months before you decide.

If you have insurance, use it

Botox for chronic migraine is commonly covered when you have a documented diagnosis and have tried at least two preventive medications. Pricked is cash-pay and does not bill insurance — so if you have coverage, going through a neurologist will almost certainly cost you less. We'd rather say that plainly than have you find out later.

Where we fit: people without coverage, people whose prior authorization was denied, and people who simply cannot get to a clinic every twelve weeks.

Migraine Consultation & Treatment

Treatment is quoted after consultation because dosing is protocol-fixed but candidacy is not.

Initial medical consultation Review of your headache diary, diagnosis, medication history and prior treatments. Credited toward treatment.
$150credited
PREEMPT treatment 155 units across 31 sites, repeated every 12 weeks. Quoted at consultation.
Quotedafter consult
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This is a medical treatment, not a cosmetic one. It requires a documented diagnosis of chronic migraine, a headache diary, and a prescription from our prescribing provider. Drew administers it.

Botox is one component of migraine management. It does not replace care from a physician or neurologist, and it is not a rescue treatment for an active migraine. Individual results vary, and some people do not respond. A sudden, severe, or unfamiliar headache — especially with fever, vision changes, weakness, or confusion — is a medical emergency. Call 911.

Common questions

Botox is FDA-approved for chronic migraine, defined as 15 or more headache days per month, with headaches lasting four hours or longer, for at least three months. It is not FDA-approved for episodic migraine — fewer than 15 headache days a month — and the evidence there doesn't support it. If you're in that group we'll tell you honestly rather than take your money.
The PREEMPT protocol: 155 units of onabotulinumtoxinA divided across 31 fixed injection sites in seven muscle groups of the head and neck. It takes about 15 minutes. The needles are small and most people describe brief pinches rather than real pain.
Treatment repeats every 12 weeks. Many people notice a difference after the first round, but the trial data showed benefit building across two cycles — so the honest answer is that you should plan on roughly six months before deciding whether it works for you. Stopping after one round isn't a fair test.
Often, yes — and if you have coverage, that is very likely the cheaper route. Insurers typically require a documented chronic migraine diagnosis and evidence that you've tried and failed at least two preventive medications, then a prior authorization. We are a cash-pay practice and do not bill insurance. We'd rather tell you that up front than after you've paid.
You need a documented diagnosis of chronic migraine from a qualified provider, and a headache diary showing your headache days. If you don't have that yet, start there. We also genuinely want you under the care of a physician for a condition this significant — Botox is one part of migraine management, not the whole of it.
Neck pain and neck muscle weakness are the most common, along with injection-site soreness and occasional eyelid drooping. These are temporary. The full risk discussion happens at your consultation, and you'll sign an informed consent that lists them.

Request a migraine consultation

Tell us your headache-day count and what you've already tried. If you're not a candidate, we'll say so.

Request a Consultation Text (262) 822-0670
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