Cosmetic Surgery Tips

What To Expect When Getting Botox For The First Time

What To Expect When Getting Botox For The First Time

Getting botox for the first time can be a nerve-wracking experience, especially if you’re not sure what to expect. In this blog post, we’ll share with you what to expect when getting botox for the first time. Botox is a drug that is used to treat various conditions including excessive sweating, migraine headaches and migraines as well as wrinkles and creases in the face. It can also be used to treat muscle spasms in the neck or back.

The procedure takes only a few minutes and involves injecting small amounts of Botox into the skin with a needle. This blocks signals from nerve endings that tell muscles to contract, resulting in temporary relaxation of those muscles.

Botox is now one of the most popular cosmetic procedures in the United States and also one of the best. Botox has been on the market since 2002, and there are many celebrities who use it to keep their skin looking young. Botox can be used for a multitude of things, from treating crow’s feet or forehead wrinkles caused by excess facial movement, to helping with migraine headaches. Read on to learn more What To Expect After Botox In Forehead/

What To Expect When Getting Botox For The First Time

As a beauty editor, I’ve been writing about the latest and greatest in the skincare and aesthetics space for years. While buzzy ingredients, tricked out lotions and potions, and new-age technologies with miracle claims pop up on the regular, there are a few tried-and-true workhorses that transcend trends. Daily sunscreen and nightly retinol usage are two such stalwarts (I’ve mastered the former but, admittedly, still haven’t found my groove with the latter), as are neurotoxin injections.

Since Allergan’s Botox® was approved by the U.S. Food and Drug Administration (FDA) for the temporary improvement of moderate to severe glabellar lines (i.e. the frown lines between the eyebrows) in April 2002, it has become the go-to for anyone looking to reduce the appearance of fine lines and wrinkles caused by facial expressions (think: frowning, squinting, smiling, and the like). Competitors like Dysport®, Jeuveau®, and Xeomin® have followed suit (get up to speed on the ins and outs of neuromodulators) — employing small doses of botulinum toxin type A (BoNT-A) to temporarily paralyze muscles for cosmetic effect. The lack of muscle contraction prevents the face from forming and/or deepening lines and wrinkles. The result? Smoother skin until it wears off.

Personally, I always felt the question wasn’t so much if I would go under the needle but rather when I would choose to do so. Even so, I hadn’t actually tried anything more invasive than a skincare routine nearing double digits in length and an occasional facial or light chemical peel. But, as a soon-to-be 29 year old whose forehead lines were no longer disappearing like they once did, it felt like as good a time as any to give it a try.

For my first Botox® appointment, I chose double board certified facial plastic surgeon Lesley Rabach, MD, of LM Medical in Manhattan because I appreciate her less-is-more approach (when she started our conversation with the refrain “cosmetic procedures are a luxury not a necessity,” I knew I was in good hands) and trust her thoroughness (she answered all of my questions, plus ones I hadn’t thought of with the patience of a saint).

“As a soon-to-be 29 year old whose forehead lines were no longer disappearing like they once did, it felt like as good a time as any to give Botox a try.”

Meg Storm

After a consultation, Dr. Rabach injected 20 units of Botox® into my glabellar lines, above my brow bone, and into my upper forehead lines. I lost count after the one injection between my brows and two above each brow, but it was no more than 10 or 12 pricks total that, despite making my sensitive eyes water, hardly felt like anything (more on the pain, or lack thereof, below!). Five days later, my results appeared; a few days after that, I went in for my follow up appointment (typical for first timers); and six weeks later, I am happy to report that I love the way it turned out.


Before & Afters: Botox

Botox Before, Female 32 - 1099
Botox After, Female 32 - 1099
profile picture




Botox Before, Female 28 - 1167
Botox After, Female 28 - 1167
profile picture




Botox Before, Male 39 - 849
Botox After, Male 39 - 849
profile picture




Botox Before, Female 26 - 1822
Botox After, Female 26 - 1822

Throughout the pre- and post-procedure process, I was most struck by how many friends said they couldn’t wait to hear about my experience because they had thought about getting Botox® — but just didn’t know where to start or what to expect. With their curiosity in mind, I’ve compiled a list of the nine things I believe are most useful to know before going under the needle for the first time:


While it may seem like people are opting to get Botox® and the like at an earlier age, there is no right or wrong time to begin treatment. As Dr. Rabach told me during my first appointment, no one needs Botox® (or any cosmetic procedure for that matter). But, if you are interested and in a position to start early, neurotoxin injections can potentially have a preventative effect.

“We are so lucky to be in a world where we can prevent many aging processes that generations before us couldn’t. Botox is a wonderful tool to use in small amounts to prevent wrinkles from ever starting.”

Lesley Rabach, MD

Needless to say, patients in their twenties and thirties will need less product than someone in their forties or fifties, but everyone will see results. “Patients who already have lines require more units to decrease the movement and often need adjunct procedures like peels, fillers, and microneedling to remove the lines that are etched in,” Dr. Rabach says. “Someone in their twenties may use a fraction of the number of units to maintain ageless skin.”


As with any procedure, finding a provider that makes you feel comfortable and, in this case, matches your aesthetic is of the utmost importance. Booking a consultation with a board certified plastic surgeon or dermatologist will help you get a sense of their work and bedside manner — and ensure that whatever you wish to have done is actually right for you. “We see new patients first for a consultation, medical history, and physical exam, followed by treatment,” Dr. Rabach explains. “Occasionally, patients want to have a consultation and wait to do the treatment on a later day, but most do both the same day.”

During my consultation, Dr. Rabach asked me where I thought I wanted Botox® as she studied my face. I explained the increasingly omnipresent nature of my forehead lines, and she proceeded to have me raise my eyebrows (my go-to facial expression), furrow my brow, and squint. Doing so allowed her to better understand my facial structure. “I assess the function of the muscles and see how exactly the different muscle groups contract and pull the skin, so that I know where to place the Botox®,” she shares. “All of the muscles of the glabella (between the eyebrows), forehead, and around the eyes (crow’s feet) attach to the skin, which is why it causes wrinkling when they contract.” Neurotoxins disrupt this relationship. “Botox® reduces the muscle’s ability to contract fully, thereby reducing/removing the wrinkle,” she adds.


Kelly, the patient coordinator at LM Medical, told me that the most common question she hears from patients other than ‘does it hurt?’ is ‘can I get Botox® during my lunch break?’ The short answer is yes.

My first appointment (which included both a consultation and injections) lasted about an hour, but the majority of the time was spent filling out new-patient paperwork, having ‘before’ photos taken, and consulting with Dr. Rabach. The injections themselves took less than 10 minutes. Post-procedure, I iced my forehead for five minutes to help with any swelling or bruising and then headed back to work. Had I not told my colleagues where I was going, no one would have suspected a thing.

Prior to injecting, Dr. Rabach wiped my forehead down with an alcohol pad, which removed my makeup. She told me I could reapply beauty products (makeup and skincare) immediately, so feel free to bring along a touchup kit.


Dr. Rabach says Botox® is “very well tolerated” by a large majority of the population for both cosmetic and therapeutic use, but it should be noted that diseases including Lambert-Eaton Syndrome, Myasthenia Gravis, ALS (Lou Gehrig’s Disease), and a few others are contraindicated. Additionally, allergies and meds should be considered.

While your daily supplement regimen won’t preclude you from getting injected, it may play a role in your recovery. “There are some supplements that potentially thin the blood, thereby making the chance of bruising — it is not very common but can occasionally occur — more likely,” she explains. “For this reason, we specifically ask about supplements. We ask about medications, of course, but have found that patients typically don’t think of supplements as medications. We like to be fully informed of our patient’s individual histories, so that we can set expectations.”

There are no medication contraindications to receiving Botox®, but aspirin and supplements like fish oil, ginseng, garlic, and ginkgo biloba (to name a few) can increase a patient’s chance of bleeding and, therefore, bruising. For the most seamless experience, lay off them before heading in for your appointment.


You may or may not be aware that Botox® arrives at your provider’s office in powder form and is mixed with saline and refrigerated prior to injecting. Because of the liquid nature of the combined formula, there is a theoretical risk that the solution could spread or move from the intended location.

After my 2 p.m. treatment, Dr. Rabach told me not to exercise for the rest of the day and to try to stay upright (read: not lay down or bend over) for three hours — but the directive was provided out of an abundance of caution. “When Botox® is mixed to the company’s recommendations, as is done in my practice, [movement] is a very rare occurrence. However, we are seeing more and more facilities that dilute the Botox® too much,” she says. “This can make it more risky for the patient to lay down or workout. At LM Medical, we recommend not to lay down or workout because we are extra careful, but it really stays where we want it.”


Yes, that kind of vibrator. During my appointment, Dr. Rabach hilariously told me that one of her early mentors gave her the tip to buy them in bulk from Amazon for the best deal… and results. Obviously, Cosmo has thoroughly covered the practice, but, in all seriousness, the vibrator serves a very useful purpose. “We have a lattice of very superficial sensory nerves and anything that touches the skin, they feel,” Dr. Rabach explains. “Using vibration during injection tricks the sensory nerves in the surrounding area to not ‘know’ exactly where the needle is coming and, therefore, makes the discomfort significantly less. Sometimes you can’t feel it at all!”

Dr. Rabach held the vibrator on the side of my forehead, asked me to make facial expressions, and injected into the lines that formed. I didn’t feel a thing, which may be a result of the vibrator or may have something to do with the fact that they quite literally use the tiniest needles on the market for the procedure. While I’ve been told I have a high pain tolerance, I don’t think anyone would tell you the injections feel like anything more than a pinprick.

Because my eyes are naturally watery, they teared up slightly, and there was a bit of blood left over that she quickly wiped away. Immediately following the treatment, there were small, bug bite-like bumps at each injection site. She handed me an ice pack to put on my forehead for five minutes and said the swelling would be gone entirely in 15 to 20 minutes. As promised, by the time I got back to my desk, there was no evidence I had anything done.

For the rest of the day, I felt like I had a very dull headache. My forehead felt a little tender to the touch (similar to how your arm feels after a vaccination) for the first 48 hours or so, but I really only noticed it when I washed my face and rubbed the area.


Given our culture is one of instant gratification, it’s important to understand that Botox® results aren’t immediate. In fact, you’ll spend the first three or four days wondering if your doctor even did anything. But, come day five, you’ll be wondering why you didn’t try this sooner. Two weeks post-treatment, you’ll be enjoying the full effect of your injections.

“Basically, I feel frozen but don’t look it. My makeup wears better without any forehead creasing, and I generally find that I look more refreshed —whether I get enough sleep or not.”

Meg Storm

I happened to be home with my family for Thanksgiving on day five, and the fact that I got Botox® had all but slipped my mind until my mom asked me if I noticed a change yet. To my delight, I looked in the mirror and saw that the small lines that had started to etch themselves above my brows were softened — almost to the point of invisibility. And, when I raised my eyebrows (yes, they still moved!), my forehead could no longer contract the way it once did. Additionally, I found it difficult to furrow my brow (though, as I mentioned, I am more of a brow raiser than a furrower), which means a temporary farewell to my eleven lines. Basically, I feel frozen but don’t look it. My makeup wears better without any forehead creasing, and I generally find that I look more refreshed (whether I get enough sleep or not!).


As Dr. Rabach explained to me during my initial appointment, not all muscles are created equal. As a result, one side of your face may be stronger than the other, which means that one side may require a bit more treatment than the other — though it will be hard for your provider to know that during your first meeting.

To ensure your injections are right for your facial structure, he or she will likely have you come about a week later (once the results have started to reveal themselves) to see if a touchup is necessary. I didn’t end up needing another needle, but the quick appointment was a good opportunity to have my ‘after’ photos taken and ask Dr. Rabach additional questions — chiefly, when I should come back for more because, in case you haven’t heard, Botox® isn’t permanent…


No matter which neurotoxin you try, the results aren’t immediate and they don’t last forever. Depending on the amount injected and the way your body processes it, most patients will find that injections last three to four months, at which point it would be time for another treatment. “Botox® degrades over time and needs to be repeated,” Dr. Rabach says. “Individual results vary depending on each person, their metabolism, how many units the person received, as well as other factors.”

And don’t bother asking what you can do to make it last longer. “I occasionally hear of it lasting longer than four months, but the industry standard is three to four months for the majority of people,” she shares. “There isn’t much we can do to make it last longer.”

The Takeaway

As you can probably tell, I am very happy with my Botox® results and can see myself getting treatments two or three times a year in the future. With that said, I went into my appointment with a few hesitations and plenty of questions, all of which my doctor was able to talk me through. If you take but one thing from this article, let it be this: finding the right provider is key. “It is entirely normal to feel nervous about doing something new, especially on your face,” Dr. Rabach says. “You almost definitely will love the results because you will look exactly like yourself, only refreshed.

What To Expect After Botox In Forehead

You may have minor side effects after Botox, including headaches, neck pain, or flu-like symptoms. You may have redness, swelling, or bruising at an injection site. You may also get indigestion. If you notice eye drooping, call your doctor right away

Botox is an injectable form of botulinum toxin that can reduce the appearance of wrinkles, help lazy eye, improve neck spasms, and help an overactive bladder. Botox is the brand name for this treatment. Other options that also use botulinum toxin include Dysport, Myobloc, and Xeomin.

How Does Botox Work?

Botox is a neurotoxin that blocks nerve signals. This keeps your muscles from contracting, easing the appearance of wrinkles and preventing new ones from forming.

Can You Exercise After Botox?

After a Botox injection, your cosmetic surgeon or a nurse will advise you on aftercare. You should avoid any exercise for at least 3 hours after treatment.

You can try frowning and raising your eyebrows about an hour after your treatment. These facial exercises aren’t necessary, but they may lead to better results.

  • Botox is used as a therapeutic treatment for many conditions, including for prevention of migraine headaches, and Botox Cosmetic is used for aesthetic purposes to lessen wrinkles like crow’s feet or forehead lines.
  • Botox and Botox Cosmetic are prescription medicines that both contain the active ingredient onabotulinumtoxinA, but they come as separate products.
  • Originally when Botox was first approved for wrinkles, doctors found it all also helped patients with migraine headaches. It was eventually approved by the FDA for migraine prevention in 2010.
  • Both treatments are given as injections into the muscles of the face, neck or head, depending upon the use. You will need more injections per session for migraine prevention than for wrinkle treatment.
  • Botox (for the treatment of chronic migraine) and Botox Cosmetic are for use in adults only.

Learn More: Compare Botox vs Botox Cosmetic

In addition to prevention of chronic migraine headache in adults, Botox is also approved to treat:

  • overactive bladder
  • leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease
  • muscle spasticity
  • cervical dystonia (abnormal head position and neck pain)
  • certain types of eye muscle problems or eyelid spasms
  • severe underarm sweating

Botox Cosmetic is approved for adults to temporarily help improve the look of moderate to severe facial wrinkles:

  • forehead lines
  • crow’s feet lines
  • frown lines between the eyebrows.

Botox Cosmetic is supplied in different unit vial sizes from Botox.

  • Botox used for migraine comes in 100 and 200 unit single-use vials, while Botox Cosmetic for wrinkles comes in 50 and 100 unit single-use vials.
  • Reconstitution and dilution instructions in the package insert vary between these two products.
  • Potency Units of Botox Cosmetic or Botox are not interchangeable with other preparations of botulinum toxin products.

Botox dose for migraine: The recommended total dose for chronic migraine is 155 Units, as 0.1 mL (5 Units) injections per each site divided across 7 head/neck muscle areas, for a total of 31 individual injections. These areas include the forehead, bridge of the nose, the temples, the neck, the back of the head, and just above the shoulder blades in your upper back.

Botox Cosmetic dose for wrinkles: The recommended dose for wrinkles varies based on wrinkle type and typically ranges from 20 to 24 units per wrinkle area. The units per injection site will vary by patient and can be determined by a qualified injector for optimal results.

Can I get Botox and Botox Cosmetic at the same time?

Yes, you can receive Botox and Botox Cosmetic for different uses at the same time as long as the total dose received of onabotulinumtoxinA does not exceed 400 Units administered in a 3 month period for adults.

You may also receive Botox Cosmetic treatment for treatment of different wrinkle areas at the same time. It is not known if Botox Cosmetic is safe and effective for use more than once every 3 months.

The dilution and the resulting units per 0.1 mL (as noted in the package insert) are different between Botox and Botox Cosmetic. Health care providers should see the specific instructions for reconstitution and administration of each product.

Warnings: Botox and Botox Cosmetic may cause serious side effects that can happen hours, days, or weeks after an injection and can be life threatening. These include:

  • Problems breathing or swallowing
  • Spread of toxin effects (leading to symptoms of a serious condition called botulism)

Call your doctor or get medical help right away if you have any of these problems after treatment.

According to the manufacturer, there has NOT been a confirmed serious case of spread of toxin effect away from the injection site when Botox has been used at the recommended dose to treat chronic migraine or when Botox Cosmetic has been used at the recommended dose to treat approved wrinkle areas.

What are Botox or Botox Cosmetic side effects?

  • dry mouth
  • discomfort or pain at the injection site
  • tiredness
  • headache
  • neck pain
  • eye problem
  • drooping eyebrow
  • urinary tract infection and painful urination
  • inability to empty your bladder
  • allergic reaction
  • upper respiratory tract infection

Review these warnings and side effects in this Medication Guide for Botox and Botox Cosmetic. Tell your doctor if you have a side effect that does not go away or that concerns you.

Bottom Line

  • Botox Cosmetic is used for aesthetic purposes for wrinkles and Botox is used as a therapeutic treatment for many medical conditions, including migraine headache prevention.
  • Botox Cosmetic and Botox come as separate products but are both prescription medicines that contain the active ingredient onabotulinumtoxinA.
  • The number of injections needed for migraine prevention are more than the number needed for wrinkle treatment.
  • Both products are given as injections into the muscles of the face, neck or head, depending upon the use. You can receive both products as long as the total amount does not exceed 400 Units administered in a 3 month period for adults.

This is not all the information you need to know about Botox or Botox Cosmetic for safe and effective use for migraine. Review the full Botox or Botox Cosmetic information here, and discuss this information and questions with your doctor or other healthcare provider.

First Time Botox Tips

  • Treatment Can Be Preventative. …
  • You May Want “Before” Photos. …
  • Your First Time Likely Won’t Be Your Last Time. …
  • Botox Is an Injectable. …
  • Eat a Light Meal and Hydrate. …
  • Wash Your Face. …
  • Numbing The Injection Site Is an Option. …
  • Apply Ice/Pressure Immediately After the Injection.

Your Personal Treatment

Botox is not usually just one injection. We commonly target more than one area of the face. As a result, the process involves a series of several small injections in the different areas for improvement. This is something we will discuss during your consultation and again at the start of your first visit.

You will decide in which areas of the face you want to see changes and to what extent. This will ultimately determine the number of injections you receive during each visit. There is no limit to the number of injections you can receive during treatment. However, we try to accomplish our goal with a minimal level of invasiveness.

How to Prepare

Eat a Light Meal and Hydrate

This is a seemingly simple directive. It’s also one many people skip prior to their first visit. Ultimately, your skin is at its best when you are taking good care of it. Prior to your appointment, drink lots of water and eat a light meal.

You’ll feel better, a full stomach will soothe your nerves, and hydrated skin will respond much better to treatment.

Wash Your Face

Wash your face before your appointment. Remove as much make-up and skincare product as possible. It’s important to start with a clean face to help identify target areas for the injections. This step also prevents interaction with bacteria.

As an added layer of protection, we will also clean your skin with a special cleanser before we inject it. This assures we’ve removed all impurities, such as cosmetic residue. We take every measure to appropriately sterilize areas of injection. This approach further underscores our commitment to a safe process.

I’ve suffered from migraine headaches since I was in my early teens. Over the years, I’ve missed out on much-anticipated trips, concerts, and family parties as I lay in bed with my head throbbing and the lights off. Migraine makes it nearly impossible to plan in advance and turns you into a flaky friend, which takes a toll on your relationships.

I thought I had tried everything-Advil, beta-blockers, Topamax-but none of them gave me the results I was looking for. Then a few years ago, my neurologist suggested I try Botox to manage my migraines. I knew about the drug’s wrinkle-reducing effects (I watch the Real Housewives franchises and Keeping Up With the Kardashians, after all), but I didn’t know that the same drug is a well-regarded preventative treatment for chronic migraine.

Admittedly I was hesitant about getting dozens of shots injected into my head, neck, and shoulders on a regular basis, but my misery made me open to trying it. Despite my initial concerns, Botox shots have completely changed how I control my migraine attacks. Though I’m still good for one or two migraines each month, Botox has drastically reduced the frequency of these attacks.

Getting Botox for my chronic migraines changed my life. What you need to know.

If you’re a fellow member of the migraine club, please accept my sympathy, and then read up on these must-know points about Botox for chronic migraine.

 The 14 Different Kinds Of Headaches You Can Get-And How To Treat Each One

First: What exactly is a migraine?

Most people believe a migraine is just a bad headache, but it can be more than that. According to the American Migraine Foundation (AMF), a migraine (sometimes just referred to as “migraine”) is a “disabling neurological disease with different symptoms and different treatment approaches compared to other headache disorders.”

It’s also important to note that, while some headaches can be the cause of underlying conditions (those are known as secondary headaches), migraines are usually their own thing. “Migraine is the most common primary headache disorder, which means that it’s not happening because of a tumor or an infection. It’s just how your brain is wired,” Umer Najib, MD, a board-certified neurologist and the director of the headache medicine fellowship program at West Virginia University, tells Health.

“Pain is often the predominant symptom, though many patients have other symptoms that can actually be more bothersome than the pain itself,” says Dr. Najib. Ferhad Bashir, MD, a neurologist with Mischer Neuroscience Center at Memorial Hermann The Woodlands Medical Center in Texas, goes a step further: “It’s a state of misery,” he tells Health. “During that time period, you’re not yourself. If you’re at work, you can’t produce at your optimum level. If you’re a parent, you can’t enjoy time with your kids.”

Those additional symptoms, aside from often disabling pain, include:

  • Sensitivity to light, sound, or strong smells
  • Nausea
  • Vomiting
  • Excessive Fatigue
  • Language, speech, or balance problems
  • Visual disturbances, like seeing zig zags, flashes of light, or blind spots.

It’s not entirely clear what causes migraine, though researchers believe that there’s a genetic component to the neurological condition, according to the US National Library of Medicine’s MedlinePlus resource. But the condition-which affects more than 37 million people in the US alone-is thought to have quite a few triggers, including stress, anxiety, caffeine (or caffeine withdrawal), and certain medications.

Migraine is also about three times more common in women, per the AMF, which points to a possible connection to fluctuating hormones. “For a lot of women with migraine, menses can trigger an attack,” Megan Donnelly, DO, a board-certified headache specialist and neurologist, and the director of headache and women’s neurology at Novant Health in Charlotte, North Carolina, tells Health. “We also have changes in migraine frequency in pregnancy and postpartum, as well as related to perimenopause.”

There’s no cure for migraines, per MedlinePlus. Instead, treatment mainly focuses on relieving symptoms and preventing or lessening future attacks through a combination of medications and lifestyle changes. This, in some cases, is where Botox-aka Onabotulinumtoxin A or Botox A-comes into play.

 5 Women on What It Really Feels Like to Have a Migraine

How does Botox for help migraine?

Botox is a preventative therapy for migraine, meaning that it can reduce the frequency of migraine, but it won’t stop one once it’s begun. Though Botox has been an FDA-approved treatment for chronic migraine for more than a decade, per the AMF, the science behind how it battles the disease is still a bit of a mystery.

Technically speaking, the AMF says that Botox is injected into the pain fibers in the head, neck, and back that are involved in headaches. That Botox then blocks the release of chemicals involved in pain transmission, which then prevents activation of pain networks the brain.

Why Botox works in this way, however, is still not well understood. “We have animal data that shows that Botox causes a change in a certain type of calcium channel in the meninges, which is the covering of the brain as well as the critical part of the migraine process,” says Dr. Najib. “We think that’s how it suppresses migraine.”

Despite Botox’s efficacy (patients reported that two rounds of shots reduced their headache days by roughly 50 percent, per the AMF), Dr. Najib notes that the drug isn’t a cure-all. “As long as the disease is still active, you’ll have breakthrough headaches,” he says.

Because of that, some patients find that they need another preventative treatment, like an oral medication, in addition to their shots. It’s also common to need a rescue drug, and the risk of drug interaction is minimal.

Choosing a treatment of preventative method for migraine is a highly personal choice that should be done in close contact with your doctor. Here’s more of what I learned about Botox and migraine during my own journey-and what I want those considering the treatment to know.

 This Explains Why You Want to Crawl Into a Dark Closet When You Have a Migraine

It’s only approved for chronic migraine

Botox is FDA-approved to treat chronic migraine in adults, which is defined as more than 15 migraine days per month. It’s not approved for other kinds of headaches, like tension or cluster, nor is it approved for children or adolescents (if it’s used for them, it’s considered “off-label use”).

You’ll have to get dozens of shots

Though migraine symptoms vary from person to person, Botox for migraine is standardized. Every three months you’ll receive 31 shots (yes, you read that correctly) totaling up to 155 units of Botox. This includes injections in specific spots in the forehead, temples, back of the head, neck, upper back, and shoulders.

If you’ve got a particular concern, like muscle spasticity or tightness in the shoulders, your provider may adjust the shot pattern to tackle that specific issue.

If Botox is working for you, there’s no known health risk associated with staying on it indefinitely, though it’s not approved for people who are pregnant or breastfeeding because of minimal studies in these groups.

The risk of side effects is low

“Botox injections can occasionally trigger a headache, muscle weakness and neck pain, but this is rare,” Kerry Knievel, DO, director of the Jan & Tom Lewis Migraine Treatment Program at Barrow Neurological Institute in Phoenix, Arizona, tells Health. “Eyelid and eyebrow asymmetry and droop can happen, but to prevent this we recommend that patients refrain from rubbing their foreheads or wearing a hat for 24 hours after their injections to prevent the Botox from spreading from the area we intend for it to be.”

In fact, Botox’s limited side effects are part of its appeal. “It’s not addicting. You don’t have to take a pill every day. It doesn’t work for everyone, but it does work for a significant amount of people. That’s why Botox is amazing,” says Dr. Bashir.

Your insurance may or may not cover it

Because it’s an FDA-approved treatment, your health insurance may cover all or most of the cost of Botox, though this depends on your specific plan. The drug manufacturer also offers a savings program that can help offset some of the expense.

To get approval, your insurance company may want to see that you’ve “failed” on two or three oral preventatives first. You may also need to keep a headache diary (I track mine in a note on my phone) that shows you’re having 15 or more headache days per month.

Once you’ve started the shots, your insurance will probably require documentation of improvement to continue paying for the treatment. Depending on your plan, you may also need to come for a follow-up visit between shots.

Note, however, that if Botox is used as an off-label treatment (meaning it’s used in a way not approved by the FDA, like in children or adolescents), insurance companies may not cover it, per the AMF.

It can take several months to see results

If you don’t experience relief from migraine right away, don’t swear off the treatment immediately. Dr. Najib recommends trying two rounds of Botox before making a decision about whether it’s working for you. Even if the treatment ends up helping after the first round, he says results typically take two to four weeks to kick in. There’s no taper required to discontinue the treatment.

It’s a little different than the Botox you receive from your esthetician

Though the same drug is used for both migraine prevention and cosmetic purposes, the amount and placement of Botox varies depending on your goals.

You may find some level of relief when you get Botox for cosmetic purposes. However, when you receive Botox from an esthetician, you’re not getting injections in the same spots as you would in a doctor’s office. This means you’ll miss the drug’s full migraine-busting effect.

You can technically get Botox for migraine and for cosmetic reasons at the same time-but you may not want to

This is where it gets a little murky, and opinions vary depending on who you ask. The manufacturer of Botox recommends not exceeding 400 units in a three-month span. Since your neurologist will administer 155 units, technically you have wiggle room if you want to visit an esthetician for Botox, too. However, this can be problematic.

“There is a theoretical risk of developing antibodies to Botox if it’s given more frequently,” explains Dr. Donnelly. If you’d like to do both, it’s best to check with your provider before booking an appointment with your esthetician.

Overall, if you’re finding yourself planning your life around your migraines, you may want to make it a point to chat with your doctor about using this multitasking drug to reduce the frequency of the attacks. I know doing so has drastically changed my life-and it might help you, too.

Leave a Comment