Botox (onabotulinumtoxinA) is an FDA-approved preventive treatment for chronic migraine — defined as 15 or more headache days per month. Given as small injections every 12 weeks, it reduces monthly headache days by roughly 50% in about half of patients, according to the pivotal PREEMPT trials.
Who is a candidate?
Botox is indicated for adults with chronic migraine: headaches on 15+ days per month, of which at least 8 have migraine features, for more than 3 months. It is not approved for episodic migraine (fewer than 15 headache days a month), where other preventives — including CGRP-targeted biologics such as Emgality (galcanezumab) and Ajovy (fremanezumab) — may be considered.
According to the American Academy of Neurology and the American Headache Society, Botox is typically offered after at least two oral preventive medications have been tried without adequate benefit.
How the treatment works
Botulinum toxin blocks the release of pain-signalling neurotransmitters (including CGRP) at nerve endings around the head and neck. Following the evidence-based PREEMPT protocol, treatment involves 31 small injections across 7 muscle groups of the forehead, temples, back of the head, neck, and shoulders. The session takes 15–20 minutes.
What results to expect
- Benefits usually begin 2–4 weeks after the first cycle
- Full effect is often judged after two to three cycles (24–36 weeks)
- In the PREEMPT trials published in Cephalalgia, patients averaged 8–9 fewer headache days per month by week 24
- Treatment is repeated every 12 weeks; some patients can space out or stop after sustained improvement
Safety and side effects
Botox for migraine has a well-established safety record over more than a decade of use. The most common side effects are temporary: neck pain (about 6% of patients), eyelid droop (around 3%), and injection-site soreness. Serious adverse events are rare. It is avoided in pregnancy and in certain neuromuscular disorders such as myasthenia gravis.
Botox for migraine in the UAE
In the UAE, Botox for chronic migraine is available through neurology clinics with physicians trained in the PREEMPT protocol. At NMC Royal Hospital Sharjah, the Headache Clinic offers assessment for chronic migraine, ultrasound-guided botulinum toxin treatment, CGRP biologics, and therapeutic nerve blocks, with consultations in Arabic and English.
If you have frequent headaches, keep a simple headache diary for one month — the number of headache days is the single most useful piece of information for your neurologist.