Botox for Chronic Migraine
Northwest DPC & Headache uses Botox therapy for patients who qualify with Chronic Migraines as part of a multimodal approach to migraine care. See below to see if you may benefit, the cost, the process, and the protocol.
Who Benefits from Botox for Migraine?
Botox (onabotulinumtoxinA) is an FDA-approved for patients who have:
15 or more headache days per month
At least 8 migraine days per month
Headaches lasting 4 hours or longer
Unlike medications taken daily, Botox is administered once every 12 weeks and works by calming overactive pain pathways involved in migraine.
Botox does not treat migraines after they start—it helps prevent them from happening in the first place. It usually also takes 2-3 treatments to know if it’s right for you.
What is the Cost for Botox?
This varies greatly based on insurance coverage. And although we are not paid by insurance as part of our clinic model, we do rely on insurance to help cover the cost of the Botox, like a traditional clinic would. But here is our best estimate.
Intake appointment: This is required to complete necessary paperwork, ensure you qualify, and cover the prior authorization work. This visit can be submitted for reimbursement by patient to their insurance. ($350)
Appointment for Botox: When we receive the Botox, this covers the visit and injection costs. This visit can be submitted for reimbursement by patient to their insurance. ($280)
Botox: The cost of the medication itself is usually cost prohibitive to bypass insurance. We work with specialty pharmacies and the Botox Savings Program to try to minimize cost to patients and ensure this is covered to the greatest degree it can be. What your insurance does not cover, the Botox Savings Program will reimburse you up to $1300 for the first injection (medication+ cost of injection visit), and $1000 after for up to a total of $4000/year.
For many patients, this means they will be covered and reimbursed the full amount, or nearly the full amount, of their Botox visits each year.
What if My Insurance Doesn’t Cover the Botox or It’s Still Too Cost Prohibitive?
If the Botox is still cost prohibitive for you, we will work with you to come up with another treatment modality that would be appropriate for you to help control your migraines. Frequently we will discuss the backup plan at your first visit so we can just order the alternative treatment for you without requiring another visit to rediscuss.
What Does the Process Look Like to Get Botox?
Evaluation
Your care begins with a focused intake migraine evaluation to confirm that Botox is appropriate for you. It then usually takes 4-6 weeks to go through prior authorization with your insurance and to acquire it for the first time.
Treatment Day
Botox is injected into 31 standardized sites across the forehead, temples, back of the head, neck, and shoulders
The procedure takes 10–15 minutes
No sedation required
You can return to normal activities the same day
Frequency
Botox is given every 12 weeks
Maximum benefit is often seen after 2–3 treatment cycles
Consistency is key—staying on schedule matters
Possible Side Effects
Botox for migraine is generally very well tolerated. Most side effects are mild and temporary, including:
Injection-site discomfort
Temporary neck soreness
Mild headache after treatment
Rarely, eyebrow or eyelid heaviness (usually resolves)
Expected Benefits of Botox for Chronic Migraine
Clinical studies and real-world experience show that Botox can:
Reduce migraine days by 50% or more for many patients
Lessen migraine intensity
Improve responsiveness to rescue medications
Reduce emergency visits and missed workdays
Botox is considered one of the most effective long-term preventive treatments for chronic migraine.
Next Steps
If you’re considering Botox, the best first step is a headache intake to confirm diagnosis, review your current regimen, and decide whether Botox or another treatment would be right for you.