Botox for chronic migraine: how the protocol works and who qualifies
Medical team, Nuance Clinic
Migraine toxin therapy is a medical intervention with a defined protocol and defined criteria. This guide explains the difference from cosmetic treatment, who is a candidate, what the injection pattern involves, and how success is measured over two cycles.
Quick facts
- For chronic migraine: 15+ headache days per month.
- Standardised 31+ point protocol every 12 weeks.
- Preventive, not a treatment for an attack in progress.
- Assess success over two cycles with a headache diary.
What it is
- The PREEMPT protocol distributes toxin over 31 or more points across the forehead, temples, back of the head, neck and shoulders.
- It reduces the release of pain-signalling neuropeptides and relieves muscular trigger points — it is preventive, not a rescue treatment for an attack in progress.
Who it suits
- Chronic migraine diagnosed by frequency and pattern
- Patients whose oral preventive medication is insufficient or poorly tolerated
- Tension-type headache with a strong muscular component may also benefit
- Not suitable in pregnancy, neuromuscular disease, or when headaches have not been medically evaluated
Products we use
Original licensed botulinum toxin type A, dosed according to the standard protocol
How the treatment is performed
- Headache history, diary review and neurological screening; referral if red-flag symptoms are present.
- Standardised injection pattern across defined muscle groups.
- Session repeated at 12-week intervals.
Safety
- Neck dosing must respect anatomy to avoid neck weakness.
- Any new, severe or atypical headache pattern is investigated before treatment.
Before your appointment
Bring a headache diary of the last 1–3 months and a list of current medication.
Aftercare
Avoid massaging the neck for 24 hours; normal activity otherwise.
Results and longevity
- Benefit usually starts within 2–4 weeks.
- The full picture is judged after two cycles (about six months).
- Many patients report fewer headache days and lower painkiller use.
Possible side effects and risks
Neck stiffness or weakness, temporary brow heaviness, bruising, injection-site pain.
Follow-up
Headache-day tracking between sessions and a structured review at each 12-week visit.
Questions about this treatment
Is this the same as cosmetic botox?
Same molecule, different protocol, dose and purpose. The migraine protocol covers head, neck and shoulders.
Will it stop a migraine attack?
No. It is preventive treatment that reduces how often and how severely attacks occur.
How long before I know if it works?
Two treatment cycles — roughly six months — is the accepted assessment window.
Ask us anything — in your language
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