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Home / Blog / Botulinum Toxin for Chronic Migraine: A Preventive Treatment That Can Reduce Migraine Days

Botulinum Toxin for Chronic Migraine: A Preventive Treatment That Can Reduce Migraine Days 03.13.2026

Chronic migraine is a neurological condition that can significantly affect quality of life. Patients experience headaches on at least 15 days per month, often accompanied by migraine symptoms such as nausea, sensitivity to light, and throbbing pain. One of the proven preventive treatments for chronic migraine is botulinum toxin type A injections (often referred to as Botox), which can reduce the number of migraine days and improve daily functioning.

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In this article, we explain who this treatment may be suitable for, how the procedure works, and what patients can realistically expect. Insights from clinical practice at MY CLINIC are provided by neurologist MUDr. Kristina Baroian.
 

What Exactly Is Chronic Migraine?

According to the International Classification of Headache Disorders (ICHD-3), chronic migraine is diagnosed when:

  • headaches occur at least 15 days per month
  • for at least three consecutive months
  • and at least 8 of those days have migraine characteristics.

This condition is more severe than episodic migraine and often requires preventive treatment strategies, not only medications for individual attacks.

Why Botulinum Toxin Helps in Chronic Migraine

Botulinum toxin type A (onabotulinumtoxinA) is a neurotoxin that has long been used in medicine in very small doses. In chronic migraine, the effect is not simply about relaxing muscles. Current research shows that botulinum toxin may also:

  • reduce the transmission of pain signals from peripheral nerve endings
  • decrease the release of certain pain mediators
  • reduce sensitivity in the migraine pain pathways.

The result for many patients can be:

  • fewer migraine attacks
  • reduced intensity of headaches
  • better tolerance of common migraine triggers.

“In chronic migraine, the goal is not only to treat one attack after another. We want to reduce the number of days when migraine takes control of your life. Botulinum toxin is one of the proven preventive options.” — MUDr. Kristina Baroian, Neurologist, MY CLINIC

Who Is This Treatment Suitable For?

Botulinum toxin treatment may be considered if:

  • you meet the criteria for chronic migraine (15+ headache days per month)
  • migraines significantly affect your work, family life, or sleep
  • you have already tried preventive medications (typically at least two different prophylactic treatments) without sufficient effect
  • or you struggle with medication overuse, which can sometimes worsen headaches.

A neurologist will always evaluate whether this therapy is appropriate for your specific condition.

How the Treatment Is Performed

The procedure is outpatient and usually takes only a few minutes. The physician injects small doses of botulinum toxin into specific points in the:

  • forehead
  • temples
  • back of the head
  • neck
  • upper shoulder muscles (trapezius).

The treatment follows the PREEMPT protocol, which is the standard method used worldwide for chronic migraine therapy. The typical regimen includes:

  • 155 units of botulinum toxin
  • distributed across 31 injection sites.

In some cases, the injection pattern may be slightly adjusted according to the patient’s symptoms. Treatment is usually repeated every 12 weeks.

When Can You Expect Results?

Some patients notice improvement within 1–3 weeks after the first treatment.

However, the full effect is often evaluated after two to three treatment cycles, meaning several months. The goal is gradual improvement, including:

  • fewer migraine days
  • less severe attacks
  • better quality of life.

“This is not cosmetic Botox. It is a precise treatment protocol developed specifically for neurology.”  — MUDr. Kristina Baroian

Safety and Possible Side Effects

Botulinum toxin therapy for chronic migraine is generally well tolerated.

The most common side effects include:

  • temporary pain or tenderness at the injection sites
  • neck stiffness
  • mild muscle weakness in the treated area.

Rarely, temporary drooping of the eyelid may occur.

The treatment is not recommended during pregnancy or breastfeeding, and potential risks or contraindications are always discussed with the physician before the first treatment.

How to Prepare and What to Do After the Procedure

Practical recommendations:

  • Bring your headache diary (recording headache days, triggers, and medications). Ideally, the diary should cover at least three months.
  • Avoid intense exercise and massage of the treated areas on the day of the procedure.
  • Maintain healthy lifestyle habits such as:
    • regular sleep
    • adequate hydration
    • regular meals
    • avoiding known migraine triggers.
  • Continue using acute migraine medications according to your treatment plan to avoid medication overuse.

When Migraine Starts Controlling Your Life

If you experience headaches on most days of the month, frequently rely on pain medication, and feel that migraine is starting to control your life, it may be time to seek specialist care.

Schedule a neurological consultation at MY CLINIC.

During the visit, we will evaluate your diagnosis, review your medical history and previous treatments, and discuss the most appropriate treatment plan — including botulinum toxin therapy if you meet the criteria.

Book a consultation
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