The Injections: Chronic Migraine and Botox Diary

What do Botox injections for chronic Migraine feel like? What is the protocol for the injections, and what can I expect from the experience? These are some of the questions we see when we talk to patients about onabotulinumtoxinA injections for chronic Migraine.

Read Part 1 of Ellen’s Botox Series – Botox for Chronic Migraine : My Diary Introduction

My Experience

Some patients are deathly afraid or at least mildly intimidated by needles. After having worked for a vet for several years, and running a horse breeding farm with animals bent on self-destruction at all hours of the day, night, weekends and holidays… I am not one of them. There’s no doubt that my experience taking injection workshops at Scottsdale Headache Symposium the past 2 years probably had something to do with that as well. I was more than ready for my first experience. I was more than ready for some relief!


I was walked into a quiet treatment room where I signed treatment forms that allowed the doctor to give me the injections.

My doctor explained where the injections would take place and asked me about any questions I might have about them. At this point, I asked about my weak neck and my concern this could lead to unwanted and painful side effects of the treatment. She examined me and agreed that because of the weakness, we might want to eliminate two of the injection points at the back of the neck until I was stronger.

At this point, because I had more detailed information about the treatment than the average patient, she explained how she does injections differently than some other doctors. This illustrates that not all doctors do the injections exactly alike, something which may surprise many patients. There is experience and skill that plays a part as well.

In her case, she gives two injections just over each eyebrow instead of the single injection some doctors are still utilizing. She also explained that, in her experience, she has found that a 1:1 dilution of serum leads to less spreading of the toxin than the usual 2:1 dilution, and asked if that was okay with me. She also explained that she finds it difficult to feel the anatomy of the muscles of the head and neck with gloves on, and asked permission to do the injections without gloves for more accurate placement of the injections. While I am definitely a gloves on kind of girl, I admitted that I did want her to be very skillful in finding just the right spots, so agreed this was okay.

I was seated on the treatment table and the table was raised to an appropriate height. We started at the back of the head. This method tends to be easier for first timers as the doctor ends up at the most intimidating areas around the face which typically causes more anxiety.

My doctor called out each muscle and side she would inject just before injecting the areas. This was helpful to me and kept me from jumping at the placement of an unexpected poke. Each area was swabbed with an alcohol swab before a prick. My hubs took photos of the process so I could share it with you here.

We began at the occipital area (back of the head) first, followed by my trapezius muscles at the tops of my shoulders. We kept to the middle of my traps to avoid weakness that could cause problems, and we skipped the muscles at the back of the neck to preserve my strength there, hopefully lessening the chance for side effects of increased pain.


I was then asked to lie down on the table, which I did with eyes closed to avoid bright lights that were necessary for her to view my anatomy appropriately.

Injections were placed in my hairline, above my eyebrows, between my eyebrows, and above my ears near my temples.


The process was very fast, and felt a little bit like a small bee sting. Two of the injections I actually did not feel at all, probably due to the extremely tiny needle that was being used. The injection points felt mildly cool, which actually soothed my head a bit — an unexpected and welcome occurrence.

After the injections, I was asked to remain lying on my back on the table for 5 minutes. Hubs and I talked about the trip home and about my hopes for the treatment I had just undergone.

Coming Soon: Week One — the Waiting Game

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


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