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Are Botox Injections Painful?

A reader asks, “I’ve been hearing about Botox. Does insurance cover it? How often do you have to have the shots and how many are there? Is it painful?”

Most insurance companies cover Botox.

Botox is FDA approved for the preventive treatment of Chronic Migraine. Most insurance companies will now cover Botox, but only if you have been diagnosed with Chronic Migraine. That means, you experience at least 15 headache days every month and at least 8 of those days meet the criteria for a migraine attack. There is almost always a pre-authorization process required before you can start receiving treatment. It is during this process that the doctor will evaluate your medical history to determine if you meet the criteria for a diagnosis of Chronic Migraine. The process usually doesn’t take too long – maybe a week or two.

Botox is an expensive treatment.

If it wasn’t for insurance and Allergan’s Botox Savings Card, my out-of-pocket cost would be almost $4,000 every 3 months. Because it is so expensive, most insurance companies require extensive monitoring to prove that it is really working. That typically means that you will be asked to track your headache and migraine attack frequency and submit regular written reports as long as you are receiving treatment. It’s a small price to pay if the treatment works.

Did I mention insurance? Yeah, you’re gonna need it. Medicare will cover Botox under the conditions I’ve described. However, they will deny most of the charges, forcing your doctor to eat most of the cost. My Medicare Advantage plan excludes almost $3,500 of the $4,000 my doctor bills. That means he gets paid less than $500 for each round of injections. Over half of that ($273) is my responsibility. That’s where the Botox Savings Card helps out. It helps cover my portion of the bill.

Understanding the process

The injection protocol for Chronic Migraine is very specific, involving 31 subcutaneous injections in the face, scalp, and neck. When my doctor teaches medical students, he uses me as his example and explains that it’s like a recipe. Follow the directions to get good results.

Several of our contributors have shared their experience with Botox. Reading their stories might help you understand the process and decide if it is right for you.

Botox for Chronic Migraine – My Experience
The Injections: Chronic Migraine and Botox
My Botox Experiment
From Skeptic to True Believer
Video of Botox Injections

What about the pain?

The injections themselves feel like I’m being pinched or stung — similar to an acupuncture treatment. So, yes, it hurts just a little. Occasionally one or two of the injection sites will sting a bit more (usually the ones on the back of my head). I’ve been able to offset that feeling by pretreating all of the injection sites with ice right before treatment. I’ve never left the doctor’s office in pain after a round of injections though.

Some people report that Botox treatments trigger migraine attacks. I’ve had eight rounds of Botox and only experienced a migraine attack after one of them. Most of the time pretreating with ice or NSAIDs will prevent this from happening. If it becomes a problem, talk to your doctor about treatment strategies.

When will it start working?

Some people respond right away, seeing relief in just a few days. Some take 2-3 rounds before seeing improvement. If you don’t see improvement by that 2nd or 3rd round of injections, then Botox probably isn’t going to work for you. However, if it is effective, you can expect to see continued improvement maxing out after the 5th round and maintaining that level of protection for as long as you keep getting injections.

How long does it last?

Botox does wear off though, so you do have to keep getting injections to continue getting benefit. For most people, relief lasts 8-10 weeks. The down side is that you have to wait a full 12 weeks between treatments, so you can see an increase in frequency during the week or two just before your next appointment.

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.


  • montanaday
    3 years ago

    I am trying to find a Medicare plan that covers Botox, but most of the plans I look at say it’s not covered. Also how are you getting the Botox savings card, as soon as I enter that I have Medicare it says I’m not eligible. Any help would be supremely appreciated. I have had Botox before when I was working and my insurance pretty much covered it but now I am on disability and Medicare. Thanks in advance.

  • Nicole
    3 years ago

    I received my 17th Botox treatment yesterday. It has been really successful for me, in combination with medication. I also take 2 medications daily as preventatives and did an increase of one over the past 3 months because I started having chronic allodynia again.

    My insurance is fairly good about it. I go to the headache clinic at Johns Hopkins and they have never had issues getting it approved. I usually hit my deductible with the 2nd treatment and only pay 10% coinsurance after that. I also started using the Botox savings card this year.

    My insurance is set to change in the new year, so we’ll see if it is still that easy. My doctor said I should also try every 4 months instead of every 3 to see if that still helps.

    At first, it felt similar to acupuncture but as I have received more treatments the needles have become more painful- the intensity of the pain has increased for me. My doctor told me that a lot of people say the injection pain increases as they receive more treatments. She is fairly quick with the injections so it is tolerable.

  • Julie R
    3 years ago

    “… For most people, relief lasts 8-10 weeks.”
    Oh, THANK GOD! I thought I was the ONLY one. I typically have what I term a “deathmigraine” for 2-5 weeks before I am due to receive my next round of Botox. (A deathmigraine is a migraine that [usually] begins in my sleep, and continues 24 hours a day for five or more days. I call it a “deathmigraine” because after four or five days, thoughts of death increase drastically; and after eleven days or so, I find myself ALMOST wishing for death.) That’s 2-5 weeks of CONSTANT headache pain, though. I had to compare six months’ worth of my PRE-Botox migraine/headache logs to six months of my migraine/headache days WITH Botox to be able to prove to myself that Botox did, indeed, make a marked difference. I went from having 4-6 migraine days per week before Botox (including two to three 7-26 day deathmigraine days) in a three-month period without Botox, to one 14-42 deathmigraine and 5-8 migraine days within a three-month period with Botox. I consider that a success. Now, if I could only find something that actually works for those deathmigraines.
    The data discomfort of the injections is minimal. I actually have two spots at the back of my neck that hit a nerve that tickles all the way down my back. My Neurologist says I’m his only Botox patient who giggles when getting injections. I’m glad I can make his day once every three months – he sure as heck makes MINE!

  • DonnaFA moderator
    3 years ago

    Hi Julie! Thanks for being part of the community and for sharing your story. You’re absolutely not alone, as you can see. I’m so glad that you receive some significant relief from Botox.

    I’m sure you do make your pain doc’s day! I imagine they don’t often get those kinds of reactions. -All Best, Donna ( team)

  • Tamara
    3 years ago

    My input about Botox in Canada since it’s a little different. 200 units of generic Botox are $800 and with my blue cross I only have to pay $25 (score! … the only good thing about my drug plan, it doesn’t cover two of my other drugs at all).

    I also have been doing trigger point injections with the same doctor twice a week for almost a year so he gives me the injections in specific placing that will help me, not just standard stops. Dr reddy does the most Botox in all of Alberta at least, if not in all of Canada so I like to think he knows what he is doing lol.

    Last time we did 9 injection spots to get larger amounts in each, the only one that hurt (and continued to pinch for a few days) was right in between my eye brows. Third round for me and only a slight improvement, but for $25 every 3 months I may give it one or two more goes ….

  • DonnaFA moderator
    3 years ago

    Hi Tamara! Thanks for sharing your story! Wow, awesome insurance!

    Have you asked your doc if there may be alternate sites he could try to increase the relief you are getting? We’ll be sending good thoughts for increased and sustained relief. -All Best, Donna ( team)

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