We offer a dedicated Botox ® Program for patients with chronic migraine and other headache disorders where Botox ® is supported by clinical evidence.
Botox ® is a well-established, neurologic treatment for chronic migraine, and in selected cases may also be used off-label for other headache conditions when evidence supports benefit and standard treatments are insufficient or not tolerated.
Our program emphasizes careful patient selection, evidence-based use, and individualized treatment planning.
Specialist assessment to determine whether Botox ® is appropriate
Evidence-based use of Botox ® for chronic migraine
Consideration of off-label Botox ® use when supported by data
Standardized injection protocols
Longitudinal follow-up to assess response and adjust care
Assistance with insurance approval and documentation
Coordination with family physicians and other specialists
This program may be appropriate if you:
Have chronic migraine (15 or more headache days per month and 8 or more migraine days per month)
Have not responded adequately to oral preventive medications
Cannot tolerate oral preventive medications due to side effects
Prefer a non-daily preventive option
Have another headache disorder where Botox ® may be beneficial based on evidence
Botox ® is a powerful tool, but not a one-size-fits-all solution.
Our approach emphasizes:
Administering Botox ® using the only proven chronic migraine protocol for chronic migraine
Appropriate patient selection
Evidence-based use
Longitudinal care and reassessment
Botox® (onabotulinumtoxinA) is a medication that works by reducing abnormal nerve signaling involved in headache disorders.
For headache treatment, Botox ® is not cosmetic. It is injected into specific muscles of the head and neck using a standardized medical protocol.
Botox ® has an established role in treating chronic migraine.
There is growing evidence supporting the use of Botox ® for other specific headache disorders (e.g., refractory trigeminal neuralgia).
Botox ® has not been shown to be effective for episodic migraine, or tension-type headache.
Botox ® works by:
Reducing release of pain-related neurochemicals (including CGRP)
Decreasing sensitivity of pain pathways in the head and neck
Lowering the likelihood that migraine circuits are activated
Although injected into muscles, Botox’s ® primary effect in headache is neurologic, not muscular.
Botox ®:
Does not suppress the immune system
Does not cause sedation or brain fog
Does not circulate systemically in meaningful amounts
Botox ® is an evidence-based, guideline-supported treatment for chronic migraine.
Clinical studies show Botox ® can:
Reduce the number of headache days per month
Decrease migraine severity
Improve quality of life
Reduce reliance on acute medications
Benefit often increases over repeated treatment cycles.
Botox ® may be considered off-label for other headache disorders when supported by evidence, such as:
Refractory trigeminal neuralgia
Certain refractory headache syndromes
Headache with prominent muscle-related pain components
Off-label use is:
Carefully discussed
Individualized
Based on symptom pattern, prior treatments, and available data
Not all headache types are appropriate for Botox ®.
Botox ® for headache is delivered using a standardized injection protocol. For chronic migraine, the only proven protocol is the PREEMPT protocol.
Small injections are placed across the:
Forehead
Temples
Back of the head
Upper neck
Shoulders
Typically 31 injection sites
Injections use a very small needle
Most people describe the sensation as brief pinpricks.
Botox ® does not work immediately
Improvement often begins within 1–2 weeks
Full benefit is usually assessed after 2 treatment cycles (about 6 months)
Mild neck or shoulder soreness
Injection-site discomfort
Head tightness or pressure
Fatigue for a day or two
Temporary eyelid or eyebrow droop
Neck weakness
These effects are usually mild and reversible.
Botox ® is typically given every 12 weeks (3 months).
Botox ® can be used:
Alone
Alongside oral preventive medications
Alongside CGRP-targeted therapies (from a medical perspective although limited by insurer's policies)
Insurance plans may limit coverage of simultaneous advanced therapies, which we help navigate.
Yes.
Botox ® use during pregnancy or breastfeeding is an area of growing evidence.
Our clinic:
Does offer Botox ® during pregnancy in selected cases
Uses an individualized, evidence-informed approach
Reviews available safety data and uncertainties
Coordinates with obstetric care when appropriate
Botox® does not affect the immune system and does not cross the blood–brain barrier.
In Ontario, insurance coverage for Botox ® often requires:
A diagnosis of chronic migraine
Prior trials of at least two oral preventive medications
Documentation of headache frequency and disability
We assist with:
Insurance forms
Prior authorizations
Treatment sequencing