Botulinum Toxin Therapy for Chronic Migraine
What is botulinum toxin?
Botulinum toxin (Onabotulinum Toxin A) is
made from a toxin produced by the
bacterium Clostridium botulinum. In high
doses it can produce muscle paralysis. In
low doses, it is used to treat many
conditions. Botulinum toxin is a medicine
approved by the FDA to prevent chronic
How does it work?
It is unclear how botulinum toxin treats
chronic migraine. Botulinum toxin
injections can cause relaxation of muscles
and can block nerve signal transmission.
The effects last about 12 weeks. It works
best if treatment is done every 12 weeks. It
may take more than one treatment to feel the
full effect of botulinum toxin therapy.
How do I know it will help me?
Botulinum toxin treatments are expensive
and come with some risk. Both your
provider and insurance consider this
treatment when less invasive treatments
have not worked for you. Botulinum toxin
has been found to work well for chronic
migraine. Most people (up to 70%) feel
some relief from migraines when treated
with botulinum toxin.
Chronic Migraine is 15 or more migraines
per month for more than 3 months. The
headaches last at least 4 hours. This does not
include chronic daily headaches, cluster
headaches, tension headaches, headaches
caused by the overuse of medicine or
hemicrania continua. Your provider will
explain the type of headache you have and
suggest this treatment based on your
headache diary and your response to other
treatments tried. Botulinum toxin therapy is
considered for people that have tried and
failed at least 3 other treatments. You often
need to submit 3 months of your headache
diaries to your insurance company and a list
of medicines that have not worked for you.
If you meet these criteria, we then consider
botulinum toxin therapy.
Does my insurance pay for this?
This treatment will require prior
authorization from your insurance. The
headache clinic will send a request for prior
authorization to your insurance company.
They will review this request. You should
receive an approval or denial letter within 2-
4 weeks. Insurance will fax a letter to the
headache clinic and we will call you when
we receive this and reconfirm your
appointment or discuss other options if
botulinum toxin is denied.
What is the treatment like?
If this is your first botulinum toxin
treatment, we suggest you have a driver. The
treatment is given in an examine room in the
headache clinic. The procedure is most
often done with you sitting in a chair.
Sometimes you will be asked to lay on an
exam table. The skin is cleansed with a
special soap to help prevent infection. The
needles used for the injections are tiny, but
do cause mild discomfort. Often people
refer to this as a pinch or pinprick feeling.
There are 31 injections placed in seven areas
of the head. This treatment takes about 15
minutes. The amount of botulinum toxin
given varies with each person.
What are the side effects?
Headaches may actually worsen for the first
2 weeks after the treatment. Please call the
Headache Clinic if this happens.
The most common side effects are:
ξ Bruising at the injection site
Other less common symptoms:
ξ Flu-like symptoms including fatigue,
nausea, muscle pain and stiffness
ξ Upset stomach
ξ Temporary drooping eyelids (for
injections given in the face)
You should not use botulinum toxin if you
are pregnant, planning pregnancy within
three months or breastfeeding. It is not
known if this treatment is safe or works for
patients under the age of 18.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 3/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7963