Migraine Botox Treatment

Migraine botox targets the mechanisms involved in pain transmission in patients diagnosed with chronic migraine, aiming to reduce the frequency and severity of attacks. It is an FDA-approved treatment protocol for this indication. It differs entirely from aesthetic botox in both injection points and dose. At my clinic in Nişantaşı, Istanbul, I carry out this treatment with the approach that comes from my background in anaesthesiology and pain management.

Who falls within the definition of chronic migraine?

This distinction matters because it determines whether the treatment is appropriate. Chronic migraine describes headache on more than 15 days a month, at least eight of which have migraine characteristics. In patients matching this picture, migraine botox is an approved treatment option.

In episodic migraine, with fewer attacks a month, the expected benefit of this protocol has not been demonstrated. When a patient presents with that picture I say so plainly and we discuss different approaches. Not offering treatment to a patient who is not suitable is the most important clinical decision in this area.

If you do not have a migraine diagnosis, or your headache has not been assessed before, the first step is a neurology assessment.

How it works

The aim here is less to relax muscles than to modulate pain transmission. The known mechanism falls under two headings:

Reducing the release of molecules involved in pain transmission. The aim is to limit the release of certain neuropeptides — CGRP in particular — released from nerve endings during a migraine attack and involved in initiating the pain process.

Reducing central sensitisation. In chronic migraine the nervous system becomes over-sensitive to pain stimuli over time. The treatment is thought to contribute to reducing this heightened sensitivity in the trigeminal pathways.

This is not a treatment that stops an attack in progress; it is a preventive treatment aiming to reduce how often attacks occur.¹ I make that distinction clear with my patients from the start.

Migraine Botox or occipital nerve block?

In migraine, the decision depends on the goal: if pain control during an attack or in the short term is the priority, an occipital nerve block comes to the fore; if long-term preventive treatment for chronic migraine is the priority, migraine Botox does. They can be planned together when needed. The final choice is made at consultation.

The block is described on the occipital nerve block page; it can also serve as a bridge until the effect of Botox settles in. The overall framework of the methods I use for pain is on the pain treatment page.

The PREEMPT protocol

The treatment follows the internationally accepted PREEMPT protocol. That means injections given according to a fixed map defined by clinical studies, not to points chosen at random.

The protocol covers 31 points across seven muscle groups: forehead, temples, back of the head, neck and shoulders. Additional points may be included according to the patient’s pain distribution. The treatment is carried out in clinical conditions and takes around 15 to 20 minutes. Very fine needles are used and discomfort is minimal.

Assessment before treatment

Before planning treatment I take a detailed pain history:

• Frequency, duration and location of the pain
• How often you use painkillers; a picture of medication-overuse headache requires a different approach
• Your sleep pattern and sleep quality
• Triggers, and any relationship to hormonal cycle
• Vitamin and mineral deficiencies, particularly magnesium and vitamin D
• Any accompanying muscle tension in the neck and shoulders

I place particular weight on the last point. Tension in the neck and shoulder muscles is a frequent accompanying finding in chronic headache; planning without assessing it remains incomplete.

How the effect develops

• Onset: the effect usually takes 7 to 10 days to be felt.
• Assessment: the real effect is assessed at the end of 3 to 4 weeks. Interpreting the result in the first week is not appropriate.
• Duration and repeat: the effect is temporary and lasts 3 to 4 months on average. In chronic migraine management, treatment is planned to be repeated every 12 weeks in line with the PREEMPT protocol.

Some patients do not get the expected response at the first treatment; by protocol, assessment is generally made after two treatments.

Visiting Istanbul or living here?

A large part of my patients are people living in Istanbul as foreign residents or visiting the city, so the practical questions come up often.

Same-day, no stay required. This is a walk-in treatment. There is no recovery period and you do not need to extend your trip for it.

Flying is not a problem. Cabin pressure does not affect the result. You can travel the same day.

Aftercare

For the best result, a few simple points on the first day are enough:

• Stay upright for the first 4 hours. Do not lie face down or keep your head bent forward.
• Do not massage or rub the treated area.
• Avoid very hot showers for 24 hours, and saunas and steam rooms for the first week.
• Avoid heavy exercise and intense cardio for the first week.
• Avoid alcohol on the day of treatment.

Mild tenderness at the injection points, or a temporary feeling of tightness in the neck may appear at the injection points and settles within a few days. Allergic reactions are rare, which is why treatments are carried out under medical supervision.

What we review together at your consultation

What we review together at your consultation

• Pregnancy and breastfeeding

• An active skin infection at the treatment site

• Neuromuscular junction disorders

• Known hypersensitivity to botulinum toxin components

• Your current medication and general health

• An existing migraine diagnosis and any neurology follow-up

• Your medication, particularly how often you use painkillers

If any of these applies to you, we plan a more suitable alternative rather than proceeding.

Frequently asked questions

How is migraine Botox different from an occipital nerve block?

The block is placed around the nerve with local anaesthetic and starts working immediately; it comes to the fore for control during an attack or in the short term. Migraine Botox is long-term preventive treatment for chronic migraine. The two can be planned together; the choice is made at consultation according to the goal.

How does it differ from aesthetic botox?

The injection points, the dose and the purpose all differ. The migraine protocol is applied not only to the face but to the temples, the back of the head, the neck and the shoulders, and the total dose used is higher than in aesthetic treatments.

Is this an aesthetic procedure or a medical treatment?

Migraine botox is a preventive treatment protocol used in patients diagnosed with chronic migraine and approved for that indication; it is distinct from aesthetic botox in both injection points and dose. The decision to treat is made after your diagnosis and pain history have been assessed.

Will the lines on my forehead change too?

The protocol covers the forehead, so some opening of the lines there is an expected outcome.

Do I need to stop my painkillers?

You do not need to stop your medication on the day of treatment. As the effect develops and attack frequency reduces, the aim is that the need for painkillers reduces alongside it. Any medication adjustment is made together with the physician following you.

Will it help my tension-type headache?

The approved indication for migraine botox is chronic migraine. The role of botulinum toxin in headaches related to muscle tension is assessed differently, and that picture needs separate planning directed at the source of the pain. We establish which picture your complaint fits at the examination.

Will my headaches come back when it wears off?

This is a preventive treatment, not a permanent solution. As the effect reduces, attack frequency can return to its previous level; this is why treatment is planned to be repeated at set intervals.

Do I need to stop my neurology follow-up?

No, quite the opposite. Migraine botox does not replace your existing follow-up; it is planned as part of it. Proceeding in contact with your neurologist is the right approach.

I am visiting Istanbul. Can this be started here?

It can, provided you already have a diagnosis of chronic migraine. Since this is a treatment planned in 12-week cycles, we also discuss at the examination how it will be continued after you return, and I am happy to correspond with the physician following you.

Can you tell me the price?

Under the applicable regulations, price information cannot be published on our website. The cost of a treatment depends on the product used, the technique chosen and the extent of the treatment. You can call the clinic for detailed information.

Sources

1. Dodick DW, Turkel CC, DeGryse RE, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50(6):921-936.
2. Aurora SK, Winner P, Freeman MC, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache. 2011;51(9):1358-1373.