The first time I watched someone’s shoulders drop after a round of Botox for chronic migraines, it wasn’t from muscle relaxation. It was relief. They had counted migraine days like storm warnings for years. This appointment was different: structured, quick, and focused on prevention. If you’re considering Botox for migraine control, the process is predictable when you know what to expect, and the aftercare is simple but crucial.
This guide covers the actual appointment flow, how dosing works, what you might feel at each stage, and how to handle the hours and weeks after. I’ll also explain timing, touch ups, common traps that lead to poor results, and how this differs from cosmetic Botox. Along the way, I’ll include practical tips from clinic experience, plus guidance on finding the right provider if you’re searching phrases like “botox appointment near me” or “medical botox injections.”
What Botox Does for Chronic Migraine
Botox, or onabotulinumtoxinA, reduces migraine frequency and intensity in people with chronic migraines, which means 15 or more headache days per month, with at least eight days meeting migraine criteria, for three months or more. It does not numb pain in the moment like a rescue medication. Instead, it changes the release of neurotransmitters at neuromuscular junctions and sensory nerve endings, so pain signaling dampens over time. Most patients count fewer migraine days by week 4 to 6 after their first treatment, with more robust control after the second and third cycles.
If your headaches are episodic, or if your pattern is more consistent with tension headaches, Botox is less reliable. Some patients with mixed migraine and neck muscle spasm benefit, especially when trapezius or cervical paraspinal tightness triggers attacks. For pure tension headaches, other therapies usually come first.
Cosmetic vs Medical Botox, and Why It Matters
The vial is the same molecule, but the plan is not. Cosmetic injections focus on dynamic lines in the frontalis, glabella, and crow’s feet for a smoother look. Medical Botox for chronic migraine follows a standardized pattern called PREEMPT, developed in clinical trials. It targets pain pathways rather than lines. Expect 155 units as a typical base dose in about 31 injection sites across the forehead, temples, back of the head, neck, and shoulders, with optional “follow the pain” sites adding up to about 195 units. Insurance in many regions covers medical Botox when criteria are met, while cosmetic injections are self-pay and priced per unit, per area, or by a flat region fee.
If you’re calling clinics after searching “botox injections near me” or “medical botox injections,” be explicit that it’s for chronic migraine prevention. Ask if they follow the PREEMPT protocol and how many migraine patients they manage monthly. A provider who only does cosmetic treatments might miss neck site nuances, which matter for outcomes and for avoiding side effects like head drop.
Deciding If You’re a Candidate
A good appointment starts before you sit down. I tell patients to bring three things: a headache diary with dates and severity, a list of tried preventive medications, and any imaging or recent neurology notes. Many insurers require that you’ve trialed at least two oral preventives or one oral and a CGRP pathway therapy before approving Botox for chronic migraine. If you’re paying out of pocket and searching “botox cost near me,” call ahead for the total price of 155 to 195 units, not just the “botox price per unit.” Unit prices vary, often 10 to 20 dollars per unit for cosmetic visits, but medical dosing uses more units and includes the clinical time to follow the protocol. Some practices offer payment plans or “botox specials near me” for cosmetic patients, but medical Botox usually doesn’t have deals because of insurance structures and dosing consistency.
Contraindications are few, but they matter. Avoid treatment if you’re pregnant or trying to conceive. Use caution if you’re breastfeeding, as data are limited. Neuromuscular junction disorders like myasthenia gravis are a red flag. Active infection at injection sites is a reason to delay. If you’ve had prior eyelid droop or significant neck weakness after cosmetic Botox, tell your clinician so they can adjust placement.
What a Typical Appointment Looks Like
A migraine Botox visit runs 20 to 40 minutes. The prep is faster once you’ve established a rhythm with your provider.
Check in and review. The clinician will ask about migraine days per month, average severity, rescue medication use, triggers, and what improved or worsened after your last cycle. A short exam checks posture, scalp tenderness, and any facial asymmetry you want to avoid exaggerating. If you also want cosmetic refinement like “baby botox near me” or a small “botox for eyebrow lift,” bring it up now. Cosmetic tweaks can often be layered carefully without undermining the migraine protocol, but dosing trade offs should be discussed.
Consent and mapping. You’ll sign a consent form that covers expected outcomes, risks like bruising, brow heaviness, or neck weakness, and rare allergic reactions. Some clinicians mark injection points with a cosmetic pencil, especially for first timers. The standard pattern includes corrugators and procerus between the brows, frontalis across the forehead, temporalis at the sides of the head, occipitalis at the back of the skull, cervical paraspinals, and trapezius. If your pain lives behind one eye or coils around the neck, they may add units in those zones.
Reconstitution and dosing. Vials are reconstituted with preservative free saline. Concentration affects spread. Many experienced injectors use 2 mL per 100 unit vial for migraine, which offers predictable diffusion and control. Expect 155 units minimum. If you’re petite with a history of neck sensitivity, they might start closer to 155 and avoid deep injections in the lower cervical region on the first session. Heavier muscle bulk in the trapezius or temporalis can justify a higher total.
The injections. The needles are fine, typically 30 to 32 gauge, and shallow for scalp and forehead sites. You’ll feel brief stings and pressure. The trapezius and cervical paraspinal points can feel more dense. Most patients tolerate the series without numbing cream. If procedural anxiety is high, an ice pack before the first few sites helps.
Immediate post care. You’ll sit upright for a few minutes. Most people walk out to work or errands. There is no sedation. Expect small blebs or bumps that settle in 10 to 20 minutes. A little pinpoint bleeding is normal. Makeup can be applied gently after the skin closes, usually within an hour, though I advise waiting until you’re back home to avoid rubbing.
What It Feels Like After
The same day, your forehead may feel tight or slightly heavy. Headache can flare for a day or two after injections, especially if you already had a background migraine. You might notice tenderness in the temples or upper neck where the needle hit a trigger point. Bruising, if it occurs, shows up more around the forehead or temples and fades within a week. A mild neck stiffness can appear around day 2 to 5. True neck weakness is uncommon when the pattern is followed, but if your head feels heavy or you find it hard to hold posture at a desk, call your clinic. They can adjust dosing or placement next cycle.
Results do not appear overnight. Cosmetic lines may look a bit softer in 3 to 5 days, but the migraine prevention effect builds more slowly. Many patients hit the first meaningful drop in migraine days at two weeks, with continued improvement through week 6. The full benefit of migraine Botox often requires two to three cycles spaced about 12 weeks apart. I tell first timers to track the trend, not the one bad week.
Aftercare That Actually Matters
You’ll see many checklists online. Most of them overshoot. The toxin stays where you put it when the technique is sound. That said, a few habits improve comfort and reduce risk of spread to unintended muscles.
- Remain upright for 4 hours after injections, and avoid pressing or massaging the sites the same day. Skip vigorous workouts, hot yoga, or saunas for 24 hours. Light walking is fine. Limit alcohol for the first night to reduce bruising and swelling. Use ice packs for 10 minutes at a time if you feel tender spots or see a bruise starting. Resume hair washing and gentle skincare the same evening, without heavy scrubbing around injection areas.
Sleeping after Botox does not require special positions, but if you tend to sleep face down or push your face into your hand, try a neutral side or back position the first night. Makeup after Botox is safe once the pinpoints have closed, but dab, don’t rub. If you get a post injection headache, your usual rescue meds are fine unless your clinician advised otherwise.
Side Effects, Risks, and How We Prevent Them
The most talked about cosmetic risks are brow heaviness and lid ptosis. In migraine protocols, these are less common because the injector respects the frontalis boundaries and balances glabellar dosing. Trouble happens when forehead lines are overtreated low on the frontalis, which weakens the elevator muscle more than the depressors. If you have naturally heavy lids or hooded eyes, tell your provider. They will keep forehead injections higher and leave enough frontalis activity to hold the brow.
Neck weakness is the side effect that interferes with comfort at work. Overly deep or low cervical injections, especially in smaller frames, can tire the neck for weeks. Good technique uses superficial placements in the cervical paraspinals and mid trapezius, with careful dosing on the first session. If you’ve had “trap tox botox” for trapezius slimming or for shoulder pain elsewhere, mention it. The combined effect can compound soreness.
Other common effects include small bruises, temporary swelling, mild flu like fatigue, and a sensation of scalp tightness. Allergic reactions are rare. If you experience difficulty swallowing, severe neck weakness, or true droopy eyelids that interfere with function, contact your clinic. Apraclonidine drops can lift a ptotic lid slightly while you wait out the effect, and future placement can be corrected.
The Results Timeline You Should Expect
Three markers tell me a patient is on track. First, a reduction in total migraine days by week 6, often from 20 days per month into the low teens on the first round. Second, shorter duration or quicker response to rescue meds. Third, lower intensity peaks, which translates into fewer missed workdays. Some patients report improvement after the very first cycle. Others feel the main benefit after cycle two.
How long does Botox last for migraine prevention? The preventive effect generally holds for 10 to 12 weeks. Some people ride it longer, but most experience increasing headaches as they approach the end of the quarter. If you feel your Botox wearing off early at week 8 or 9, tell your clinician so they can evaluate dosing and placement next time. Extending the interval to 16 weeks usually leads to a rebound. On the flip side, compressing to every 10 weeks can help certain patients with fast metabolism or severe disease, but insurers might not approve shorter intervals. When out of pocket, plan your budget for a consistent 12 week cadence.
Why Botox Sometimes Doesn’t Work, and What We Adjust
“Why Botox didn’t work” is a common message I see two to four weeks post treatment. The timing is usually the answer. Full impact takes longer. Another pattern: under dosing in the temporalis and occipital areas when those are the patient’s main trigger points. When we review the map and add units to the “follow the pain” sites, the next cycle performs better.
Anatomy matters. A high hairline, a strong corrugator, or a forward head posture from desk work can shift where pain lives. A one size fits all map ignores that. The PREEMPT protocol gives a consistent base, but the art is in adjusting for actual pain geography, body size, and previous side effects. If you felt brow heaviness, we modify forehead placement. If your neck stiffened, we stay more superficial and reduce lower cervical dosing. If you grind your teeth or clench at night, adding masseter injections for TMJ pain can reduce a major trigger, though that’s separate from the migraine protocol.
Coordinating With Other Treatments
Botox pairs well with traditional preventives and CGRP inhibitors when needed. I often see patients who combine Botox for chronic migraines with lifestyle adjustments: consistent sleep, hydration, magnesium glycinate, and paced screen breaks. If your attacks peak with menstrual cycles, discuss timing prophylaxis around that window.
Combining cosmetic touches like Botox for crow’s feet or a subtle Botox for eyebrow lift is possible on the same day, but dose accounting matters to avoid diffusion or heaviness. Fillers in the midface or temples can be scheduled the same day or a week apart. For first timers, I prefer spacing fillers by a few days so we can attribute any swelling or bruising to the right source. If you’re hunting “botox and fillers same day” because of travel, tell the clinic in advance so they can plan timing and sequence.
Cost, Units, and Finding a Qualified Provider
Pricing models confuse almost everyone. Cosmetic visits are often marketed by region or with promotions like “botox deals near me,” where you see a lower “botox price per unit.” Medical dosing uses more units and more anatomy, so the total is higher. If you pay cash, ask for the total fee for 155 to 195 units, plus any visit charge, and confirm whether a touch up is included. If you rely on insurance, confirm that the practice can submit prior authorization for chronic migraine and whether you owe an administration fee.
Unit ranges for cosmetic areas, as context, often look like this: 10 to 20 units for glabellar frown lines, 6 to 15 per side for crow’s feet, and 8 to 16 spread across the forehead, depending on forehead height and strength. These numbers help you sanity check the scale difference when you hear 155 units for migraine prevention. The intention is not to freeze expression, but to modulate sensory input along known pain pathways.
When vetting “top rated botox near me” or “best botox near me” listings, read beyond star ratings. You want volume and experience with migraine protocols, not just smooth foreheads. Good questions include: How many migraine patients do you treat monthly? Do you use the PREEMPT pattern and follow the pain? How do you adjust dosing if someone had neck weakness last cycle? Who performs the injections, and how many years have they treated chronic migraine with Botox?
If cost sensitivity is top of mind and you’re comparing “affordable botox near me” or “botox cost near me,” balance price with experience. A slightly higher fee from a clinician who prevents complications is cheaper than a discount session that triggers three weeks of neck strain.
Special Cases Worth Flagging
Athletes and heavy lifters often metabolize faster, or they notice earlier wear off because neck and shoulder demand is high. We plan injections a North Carolina botox options few days before a lighter training block and respect the 24 hour rest window.
Desk workers with forward head posture frequently hold tension in the cervical paraspinals and trapezius. They can benefit from physical therapy or ergonomic changes alongside Botox. If you felt relief but posture pulls you back into headaches by week 8, pairing treatment with neck strengthening and daily micro breaks extends the benefit.
If you have significant asymmetry in the brows or forehead lines, mention it before injections. Migraine protocols occasionally unmask a pre existing asymmetry. A small cosmetic adjustment can keep the look balanced while preserving the medical effect.
Patients with bruxism who ask about masseter Botox for jaw clenching or teeth grinding can combine treatments. Masseter botox for jawline slimming is a cosmetic byproduct, but the functional win is reduced clench force and fewer morning headaches. Masseter exposure typically starts at 20 to 30 units per side and titrates based on muscle size. If you already receive migraine Botox, the total toxin load must be considered.
What Not to Do After Botox, Without the Myths
Common myths tell you to avoid every movement and skip skincare for days. That’s not necessary. The real mistakes are pressure, heat, and vigorous activity too soon. Don’t book a massage the same day, especially not a face or scalp session. Don’t lean into a salon sink for a hair wash straight after. Don’t wear tight headbands or compressive hats for several hours. You can shower, apply sunscreen, and use gentle cleansers. You can work, read, and drive.
Alcohol, within reason, is more about bruising than Botox spread. If you had more than a few forehead or temple sites that bled, give it a night. If you didn’t bruise and you want a glass of wine with dinner, it won’t erase your results.
Touch Ups, Missed Spots, and When to Call
Migraine protocols rarely use touch ups the way cosmetic visits do, because the clinical endpoints are headache days rather than line smoothing. That said, if a specific pain zone was skipped or under dosed and you flare consistently there, a small supplemental session within two to three weeks can help. Many practices avoid early add ons to reduce insurance complexity, so clarify policy at your first visit.
Call the clinic if you notice new or asymmetric eyebrow droop, significant neck weakness, difficulty swallowing, or sustained headache worsening beyond a few days after treatment. Call as well if you approach week 8 and feel the effect sliding early. Documenting patterns guides the next cycle’s plan.
Planning Your Next Three Cycles
The best outcomes come from consistency. Plan three cycles at 12 week intervals. Track migraine days, severity, rescue use, and any side effects. Each visit, revise the map by what your diary shows. If your left temple stopped throbbing but the occipital region still sparks at night, the “follow the pain” units shift there. If you developed heaviness in the mid forehead, those injections lift a centimeter higher or lose a few units.
This is also the window to discuss adjacent concerns. If long screen time carves lines between your brows and you’re considering preventative care for 11 lines, your provider can adjust the glabellar dose without compromising function. If down the line you want a small brow lift for hooded eyes, careful placement above the tail can help open the eye while maintaining a natural result. The key is communication, anatomy, and restraint.
Final Practical Notes
- If you need a same day botox appointment because a work trip is coming, remember that migraine relief will not be immediate. You may feel tender, not better, for a day or two. Plan ahead when you can. Walk in botox near me searches work for cosmetic touch ups in some cities, but medical migraine sessions are best scheduled to allow time for assessment and prior authorization. Keep expectations clear. A realistic target is a 30 to 50 percent reduction in headache days over the first two to three cycles. Some patients do better, a few do less, and adjunct therapy fills the gap. Bring your real life. If you manage toddlers, lift equipment, or sit on flights weekly, tell your clinician. Lifestyle informs placement and aftercare advice.
The goal of migraine Botox is quieter weeks, not a perfect forehead. If you prepare with a simple diary, choose a provider fluent in the migraine protocol, and follow the modest aftercare steps, the process feels routine and the benefits add up. The day I described at the start ended with the patient taking a photo of the injection map on the chart. Not for social media, but for control. That’s a good instinct. Ask questions, review what worked, and let each cycle teach the next.