BOTOX® (Botulinum Toxin A) Treatment for Migraines

The Only Treatment for Long-Term (3-6 month) Preventive Relief of Migraine Headaches


In 1992, while conducting studies on the use of BOTOX for treating facial wrinkles, Dr. Binder noticed a correlation between the use of BOTOX and the alleviation of pain in the wrinkle study patients who also had migraine headache symptoms.

Dr. Binder continued to study these effects and went on to devise an injection protocol for the use of BOTOX  to treat migraines, which was used in a combined multi-center, open label study to assess the efficacy of BOTOX in the prophylactic management of migraine headaches and related symptoms. In 1999, Dr. Binder presented his findings to several surgical and headache organizations.*

As a pioneer in the use of BOTOX for wrinkles and the discoverer of its effect on relieving migraine pain, Dr. Binder is one of the world’s most experienced physicians in the use of BOTOX.  His injection protocols for both wrinkle and migraine treatments are used by health professionals worldwide. He is a leading investigator and authority on the uses of BOTOX and has contributed to top medical journals and text books and is widely cited in the consumer media.

Introduction to Botox for Migraines


Characterized by moderate to severe head pain aggravated by movement or physical activity, migraines are an episodic disorder with neurologic, gastrointestinal and autonomic symptoms. More than 23 million Americans (17% of women and 6% of men) suffer from migraines, which can last anywhere from 4 to 72 hours, and may also be associated with nausea, vomiting, and light and sound sensitivity.

The exact way that BOTOX works to relieve migraines is not yet known. Botulinum toxins are known to have a blocking ability not only at the neuro-muscular junction but at the cellular level as well. When injected directly into overactive muscles, BOTOX inhibits the release of acetylcholine, a neurotransmitter released from nerve endings that causes muscles to contract. This blocks the nerves impulses and results in inhibition, or relaxation, of the muscle. It is suggested that BOTOX actually inhibits pain pathways through multiple actions at the neurotransmitter level and pain fiber level.

Dr. Binder injects a series of small injections of BOTOX in specific areas across the frontal, temporal and glabellar regions of the forehead. In some instances, it is also injected into the back of the neck. The injection location and dosing are critical for achieving an effective, long lasting result that is free from undesired side effects. The treatment takes about fifteen minutes, is easily administered during a routine office visit and you can quickly return to work or normal activity.

After injection, it takes 2-3 days for BOTOX to begin taking effect. The effect lasts for 3 months or longer.

The safety profile of BOTOX is considered to be excellent. BOTOX has been used by patients with various conditions for over 20 years in over 60 countries. The most common side effects are localized pain, tenderness or bruising at the site of injection. These side effects are normally local and transient in nature.

The BOTOX formulation does not contain the intact bacteria, Clostridium botulinum. Therefore, use of BOTOX cannot cause botulism. Toxicity from the use of BOTOX is rare due to the minute quantities of botulinum toxin injected for clinical uses. It is estimated that over 3000 units would be required to actually cause illness.

BOTOX cannot be compared to other treatments. In those patients where BOTOX was effective, it eliminated pain and related symptoms of migraine (nausea, vomiting, photophobia, etc) for approximated 3 months. There is no other therapy that has this prophylactic ability. By way of comparison, the widely prescribed triptan class of agents (such as Imitrex®) are commonly used as treatment only during or before an acute onset of migraine and have a duration of action for only hours.

Studies have shown that there are a number of problems and concerns with the use of painkiller medications for treating migraine headaches.  In addition to the dangers of overuse including addiction and side effects, studies have shown that overuse of painkillers for migraines can actually backfire and “rebound” with the pain returning even worse than before.

In a study by Dr. Binder and associates, BOTOX was shown to also benefit chronic daily headaches and tension-type headaches as well. The results, however, were not as consistent as with group of patients diagnosed with true migraine headaches.

Although many physicians and even non-medical personnel can administer BOTOX for any purpose, the effectiveness and results can vary widely.  Although this rule applies to the use of BOTOX for wrinkles, it is even more critical for this newer application of BOTOX for migraines.  Though rare, because of the muscle paralyzing effects of BOTOX, side-effects ranging from the cosmetic (droopy eye lid) to potentially health threatening like paralyzing muscles used to breathe and swallow, are possible.


*The initial findings were presented by Dr. Binder at the 15th Annual Scientific Meeting of the American Academy of Cosmetic Surgery (AACS) in January 1999, and at the American Academy of Facial Plastic and Reconstructive Surgeons in May 1999, at the Annual Meeting of the American Association for the Study of Headache (AASH) in June 1999. The final data of the original study was presented at the Annual Meeting of the American Academy of Otolaryngology and Head and Neck Surgery in New Orleans on September 28, 1999.