Botox Migraine Injection Sites: Where are Patients Injected?

I have recently been injected for my migraines after trying many other options. Is there a range for how much you use or a typical area to inject.

Doctor Answers (4)

Injecting Botox for Migranes

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Treatment of migranes is a very individualized process.  The first step is to see a qualified plastic and reconstructive surgeon that can understand and guide you through the multiple surgical and nonsurgical options.  The patient must present with an active migrane.  Only migranes that are triggered by compression of peripheral nerves can be treated with botox, luckily at least in my practice this includes the majority.  A plastic surgeon with craniofacial experience can easily identify the possible locations of triggering and a diagnosis is made by stimulating and relaxing the muscles manually with special massage techniques or injecting a small amount of lidocaine near the triggering nerve.   If the migrane is treated, the diagnosis is made and options are reviewed.  The next step is to give the patient a trial of local muscular relaxation with botox administration which must not only significantly chemodenervate the local muscles, but also must be balanced through the face so as not to create an aesthetic deformity.  depending on level of relief, duration of relief and patient preferences, most patients opt for a permanent treatment without recurring cost.  The identified trigger nerve is decompressed in a quick in office surgical procedure and a small amount of fat is placed around the nerveto cushion and protect it from further irritation.   Patient staisfaction is very high with this protocol.  Remember there are many practitioners that will be willing to inject Botox for migranes who do not have the anatomical, physiological or surgical knowledge and experience to produce a result.  I strongly recommend seeing a plastic and reconstructive surgeon who can guide you.

All the best,

Rian A. Maercks M.D.


Miami Plastic Surgeon
5.0 out of 5 stars 37 reviews

Where are patients injected for migraines

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Although there is still  great controversy in scientific circles about the true effectiveness of Botox (Double blind studies have shown only mild effectiveness), many of us use it and many patients are satisfied. In some cases a placebo effect may be at work,

Dermatologists should not make a diagnosis of migraine. This diagnosis should be made by an Internist or a Neurologist.

Once the diagnosis is secure,the injections should be given exactly in the area of maximum pain after having the patient describe the quality  and severity of pain.

Apparently Botox also helps many patients who have non migraine chronic headaches.

Eugene Mandrea, MD
Chicago Dermatologist
4.5 out of 5 stars 4 reviews

Botox is the best treatment for chronic migraine headaches

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Botox is the best treatment for chronic migraine headaches. In order to get maximum improvement the path of the headaches is detailed and the muscles involved in that pathway are injects. For instance some cases will require neck injections, some forehead injections, and some cheek injections.

Edward Lack, MD
Chicago Dermatologist
3.0 out of 5 stars 5 reviews

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Follow-the-pain is a common approach when injecting BOTOX® for migraine

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In my experience of several hundred cases over the past 7 years, the most effective way to use BOTOX® for the treatment of migraine and other headaches is to inject the BOTOX® where the patient indicates the pain starts or travels to.

This means taking a careful history, planning the treatment before starting to inject, and working closely with the patient during the injection session. BOTOX® treatment to control headache works best when it is customized to the individual being treated. On the face, even if pain is one-sided, it is important for treatment to be symmetrical in order to avoid uneven relaxation of the muscles of facial expression.

Treatment can sometimes extend onto the temples, sides of the scalp and back of the neck.

Each injection point generally receives 5-10 units of BOTOX®. The total dose in a treatment session generally ranges from 60-180 units, depending on the patient's needs. Patients return every 2-6 months for repeat treatment, with most patients returning every 3-4 months [similar to the schedule followed by many aesthetic patients.]

In quite a few cases, headache is associated with or complicated by bruxism [grinding of the teeth] and/or temporo-mandibular joint [TMJ] pain. Treatment of the masseter muscles with 3-4 ten unit doses of BOTOX® on each side is usually very beneficial in these cases.

Some headache patients improve dramatically after treatment with BOTOX®, but most improve in a stepwise manner, gradually noting reduced consumption of headache medications [triptans, NSAIDs and narcotics], and gradual improvement in mood and activities of daily living. Patients are often pleased to have a treatment which produces positive side effects instead of the negative side effects they experienced with triptans, NSAIDs and narcotics.

Kevin C. Smith, MD
Niagara Falls Dermatologic Surgeon
4.0 out of 5 stars 2 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.