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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.


  • thomas51
    7 years ago

    Have to say it was the one thing that worked for me. I have common temporal migraine that ruined my life for 30 years, they lasted three days at a time and was suffering anxiety from the fear of that terrible pain/sickness you all know. Found that it was the corrugator and temporalis muscles that I needed to relax and have managed to do this without any more botox. We are in control of our muscles we just have to learn what makes us use them. Botox can be an excellent diagnostic if one of your triggers is muscles/nerves, it can be put into one area at a time to home in on where the problem is. The corrugator muscles make us frown and help protect our eyes during washing/showering and from bright light low in the sky/windy weather, also to express emotions of stress; anger; resentment; frustration. The temporalis is used when chewing and strongly engaged during bruxism (clenching and grinding during sleep), a hard splint can be made by a dentist to stop this. I also keep away from foods high in nitrates and nitrites especially E250 and in particular any aged and processed meats plus the precursor to nitic-oxide L-Arginine found in the increasingly popular whey protein powder. Hope that helps someone with this dreadful illness.

  • Chapreca
    7 years ago

    Thanks for posting your journey! I’ve been battling migraines for the past 33 years & have recently switched neurologists. The very first thing he offered me for treatment was Botox…which I had my first round back in Nov. my headaches seemed to have gotten worse before I had relief. I’m due my second round in March, & they are starting to really come back w/a vengeance. Also, I found that since I’ve had the Botox, I’ve had a lot more tension in my shoulders & back(it was there before, but now more pronounced). But I guess I’m willing to give it a couple more rounds to work, especially since my insurance covers it 100%

  • Nola
    7 years ago

    I’ve been through three rounds of Botox injections. My next one is due in less than two weeks. It has reduced my frequency by nearly half. I still need triptans, but at least they have a fighting chance to actually work now – instead of something like a garden hose fighting a forest fire. I tried Lyrica. No dice for me. I appear to be sensitive if not downright allergic to it. I do find that the “migraine rage” is less now too. However, when it starts getting close to the end of the 90 day cycle for injections, the frequency, duration, and intensity picks up again. As does the irritability.

  • Paulaff
    7 years ago

    I know what you mean about almost being ‘allergic’ to a med. I’ve had that problem with many other preventive drugs. With me, some meds work for a few months, but then are no longer effective, so we have to change again. I haven’t experienced the ‘rage’, though, so I guess I’m lucky in that regard. After 20 yrs of daily chronic migraines, I would have thought they’d have a med specifically made for migraine prevention!

  • Paulaff
    7 years ago

    I had Botox injections in Dec & was told it would take up to 2 wks to work. Well, it never worked. There was absolutely no benefit at all, in fact, the migraines increased severely for a couple of wks before settling down to my usual daily afternoon marathon.
    So now, with a new neurologist, I’m taking Lyrica, & it seems quite promising. They’re not gone, but are reduced in severity.
    Yea to anyone who is getting relief from the Botox. All we want is a (somewhat) normal life with less pain.

  • Leigh
    7 years ago

    I have been receiving Botox shots for about 15 months. It has reduced the severity significantly overall (from an average 4-7 daily to an average 2-5 daily), though the frequency still remains high. I had some aggravating factors last year that I’m sure kept it from working better.

    I, too, have neck problems and am glad you raised that issue as I am wondering if that is why I am still getting so many migraines and headaches. The true migraine attacks are not nearly so painful as the occipital/cervicogenic headaches. Those can hit the 7-8 range or turn into migraines if I’m not quick to head them off.

    Botox hurts like a bugger given there are 32 “bee stings” involved when I’m getting the shots, but I definitely feel it’s worth it.

  • lln001
    7 years ago

    Ellen, great thing you are sharing your story with others. I just had my first round of botox last week and am in my waiting game to see if I get any relief. I also have a stimulator implanted so my injections areas were a little different than mine. Before the stimulator I had a migraine every day and was very ill and missed a lot of work and activities. Now I only have about 7 days of migraines. A great improvement but my specialists thinks they might be able to get it to 3 or 4 days. Wouldn’t that be something. My insurance is going to cover my after my $2,500 ded is met. I will get it every 90 days so it looks like I will pay for 2 and the insurance will pay for 2. Do you know why we have to wait before we see results? I can’t remember what they told me.

  • Ellen Schnakenberg author
    7 years ago

    lln001- The toxin takes time to do its work. Also, it may 2 or 3 injection cycles to get full benefit. This is because the affects tend to build, cycle after cycle.

    I will keep fingers and toes crossed for you and hope that you see some results. I’m amazed they put a stim in before trying this first though. Did they have a reason for that by any chance? I’m just glad you’re seeing results. Lots of patients don’t understand that we often have to dogpile different therapies, one on top of the other, to get best results. You are a perfect example of trying this and I really hope it works!

  • Cindi
    7 years ago

    I’m going to print this and take with me to my appointment on the 15th, just to see if my injection sites are similar. I hope my doctor goes into my shoulders like yours did! Thanks, Ellen!

  • Ellen Schnakenberg author
    7 years ago

    Good luck Cindi – I hope you’ll come back and tell us how it went!

  • caryd26
    7 years ago

    Thank you so much for sharing! I’ll be watching as you progress. My friend says she commonly feels nauseated for a day or two afterwards, but then has up to 3 months of relief. I myself am waiting to try botox for migraine. My insurance has denied it twice and I have to file an appeal. I’m considering just paying for it the first time to see if it’s even worth it. I think it’s definitely worth trying rather than trying another systemic preventative. Good luck!

  • Ellen Schnakenberg author
    7 years ago

    CaryD – Something to consider: It may take three cycles/rounds of injections before many patients finally feel the effects they’re hoping for. I know it is so very hard to wait for insurance, but for me, doing otherwise would have necessitated selling my home and uprooting my family – something I wasn’t willing to do in light of everything I have already put them through. It took a very long wait (many years) before I was finally able to try it. I suffered so much during that time. However, I always carried hope that eventually I would get the chance to try it. I am not sorry for the experience, just wish they would have added it as a treatment much earlier.

  • simplygourdjus
    7 years ago

    Great info! & detail! Thanks for sharing and keep us updated, please.

  • Ellen Schnakenberg author
    7 years ago

    simplygourdjus – Thank you for taking the time to comment! I know adding all the detail makes it longer to read, but I have met so many patients online who are so afraid of trying this treatment that I really wanted them to feel like they were in the room with me, in hopes they will gain the confidence they need to trial it appropriately.

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