Quick Answer
OnabotulinumtoxinA is an FDA-approved preventive for chronic migraine in adults, given as a set of small injections on a fixed schedule. Candidacy rests on a numerical threshold rather than severity: fifteen or more headache days a month with migraine features on at least eight of them.
Part ofThis guide sits beneath headache and migraine, which covers the study itself, how it is performed and what the report should contain.
Headache and Migraine evaluation and management →Key Takeaways
- It is preventive, aimed at reducing how often attacks happen. It does nothing for an attack already under way.
- Candidacy is a number, not an impression: fifteen or more headache days a month, migraine features on at least eight.
- A month of dated diary entries is usually what establishes whether that threshold is met.
- Injection sites and sequence follow the protocol the evidence was built on, which is why they are not moved to where the pain is.
- It is administered in-office by CNS neurologists at both offices. This is not cosmetic injection, and the practice performs none.
OnabotulinumtoxinA
OnabotulinumtoxinA is a purified protein that reduces the release of chemical signals at nerve endings. Injected at fixed sites on a repeating schedule, it is an FDA-approved preventive treatment for chronic migraine in adults, aimed at reducing how often attacks occur rather than at relieving one already under way.
What the treatment actually involves
The threshold, and why it is a number
Chronic migraine is defined as fifteen or more headache days a month with migraine features present on at least eight of them. That is a numerical definition rather than a description of severity, and it is what determines candidacy for this treatment. Most people substantially underestimate their count when reconstructing from memory, which is why a month of dated entries is worth more than any description of how bad the worst day was. Episodic migraine, meaning fewer than fifteen headache days, is managed differently.
The appointment itself
A set of small injections across the forehead, temples, back of the head, neck and shoulders, following an established protocol. Each feels like a brief pinprick or sting and the appointment is short. No sedation is used, so you can drive yourself home. Some patients notice neck soreness or a mild headache for a day or two afterwards, and paracetamol or an ice pack is usually sufficient. Most people return to ordinary activity the same day.
Judging whether it worked
Assessment usually needs more than one treatment cycle, and it is judged on the change in headache days per month rather than on individual attacks. Treatment runs on a fixed schedule, so appointments are booked in advance rather than arranged attack by attack. Continuing the diary through that period is what makes a fair judgement possible. Where an unrecognised medication overuse pattern is present, addressing it usually has to happen alongside.
| Also considered | How it is distinguished |
|---|---|
| Tension-type headache | Pressing, bilateral pain without nausea, aura or movement sensitivity. |
| Cluster headache | Strictly one-sided, 15 minutes to about 3 hours, with tearing, nasal congestion or a drooping eyelid, and restlessness rather than stillness. |
| Medication-overuse headache | A pattern change: headaches become more frequent as acute medication use rises, and the history rather than a scan identifies it. |
| Secondary headache | Red flags — sudden 'worst-ever' onset, fever with neck stiffness, new deficit, or onset after head injury — prompt urgent imaging rather than a headache diagnosis. |
How it is given, and what the practice does first
01
What brings people in
Frequent or changing headaches, attacks that are no longer controlled by what used to work, or a new headache pattern that needs an explanation.
02
What the evaluation settles
Which headache disorder the pattern fits, whether any red flag needs imaging, and which preventive and acute options are appropriate.
03
What you leave with
A named diagnosis where one can be made, a written acute and preventive plan, and a follow-up interval to judge whether it is working.
A fixed pattern, not placed where it hurts
A series of small injections at set points across the forehead, temples, back of the head, neck and shoulders. The sites and sequence follow an established protocol rather than targeting your own pain pattern, which surprises patients and is deliberate: the protocol is what the evidence was built on, and varying it means the treatment is no longer the one that was studied.
What it feels like, and afterwards
Each injection feels like a brief pinprick or sting. The appointment is short. No sedation, no fasting, no driver needed. Some patients notice neck soreness or a mild headache for a day or two, and avoiding rubbing the injection sites for the rest of the day is the only restriction.
Diagnosis and overuse checked before anything is administered
The practice does not administer this treatment on request. Candidacy is established by a neurologist against the chronic migraine definition, medication overuse is looked for, and alternatives are weighed, because for some patients a different option fits better. Coverage and prior authorisation are completed before the appointment rather than discovered at check-in.
What it is not
Not cosmetic. This is a neurological treatment for a diagnosed headache disorder administered on a clinical protocol, and the practice performs no cosmetic injections. It is also preventive rather than acute: it aims to reduce how often attacks occur and is judged on monthly headache days across cycles rather than on whether it stopped one headache.
The first 30, 60 and 90 days
Step 1
First visit
History and neurological examination, a review of records and prior imaging, and a decision on which studies are actually indicated. You leave with the plan, not just a referral.
Step 2
Within 30 days
Indicated in-office studies are performed and interpreted by the neurologist who ordered them, in our AANEM-accredited laboratories. Results are explained in plain language.
Step 3
60 to 90 days
Follow-up to judge whether the plan is working, adjust it, and coordinate with your referring clinician. Where a diagnosis needs time to confirm, this is where it is revisited.
Think you meet the chronic migraine definition?
Bring a month of dates and what you took. That record is what establishes candidacy.
The Bottom Line
Bring a month of dated headache days and your full medication list, including anything bought without a prescription. Those two things establish whether the threshold is met and whether a medication overuse pattern needs addressing first. Both are more useful than any account of how severe the attacks have been.
Frequently Asked Questions
What is Botox for chronic migraine?
OnabotulinumtoxinA is an FDA-approved preventive treatment for chronic migraine in adults, given as a series of small injections at fixed sites on a repeating schedule. It is aimed at reducing how often attacks occur rather than at stopping one in progress, and it is administered in-office by CNS neurologists at either location.
Who qualifies for it?
Adults with chronic migraine, meaning fifteen or more headache days a month with migraine features on at least eight of them. That numerical definition rather than headache severity is the threshold, and it can only be established from a headache record kept over time. A month of dated diary entries is usually enough.
Does it treat a migraine that has already started?
No. It is preventive, aimed at reducing how often attacks occur over a month. Judging it on whether it stopped a single headache will always make it look like a failure. Acute treatment for individual attacks continues alongside it, and the two are prescribed to do different jobs rather than to replace one another.
Does it hurt?
Each injection feels like a brief pinprick or sting and the appointment is short. No sedation is used, you can drive yourself home, and some patients notice neck soreness or a mild headache for a day or two. Paracetamol or an ice pack afterwards is usually sufficient, and most people return to ordinary activity the same day.
Why are the injections not put where my pain is?
Because the sites and the sequence follow an established protocol that the evidence was built on. Varying it to target an individual pain pattern means the treatment is no longer the one that was studied. Additional sites can be added within the protocol where the pattern justifies it, but the standard set is always covered first.
How long before I know whether it is working?
Assessment usually needs more than one treatment cycle, judged on the change in headache days per month rather than on individual attacks. Continuing a headache diary through that period is what makes a fair judgement possible. Treatment runs on a fixed schedule, so appointments are booked in advance rather than arranged attack by attack.
Is this the same as cosmetic Botox?
No. This is a neurological treatment for a diagnosed headache disorder, administered on a clinical protocol at fixed sites. The dose, the sites and the intervals are all different, and it is billed as a medical treatment, which also affects how your insurance handles it. The practice performs no cosmetic injections.
Do I need to have tried other preventives first?
Most insurers require documented trials of older preventives before approving this treatment. Our team gathers that history and completes prior authorisation before the appointment rather than after a rejection. Where a required trial genuinely cannot be tolerated, that is documented as part of the request rather than treated as a dead end.
What if I do not meet the definition?
Other preventive options exist, including CGRP therapies, which do not require the chronic migraine threshold. Oral preventives, nerve blocks, and addressing sleep and where relevant blood pressure or mood are all part of the same conversation, and the diary you keep in the meantime frequently reclassifies the picture anyway. Bring a month of dated entries and the conversation starts from evidence.
Which office is it given at?
Both. Whichever is the shorter drive, since both administer the in-office preventives and hold the same records. That matters more for this treatment than for a one-off appointment, because it repeats on a fixed schedule, so a shorter journey compounds over years rather than costing you once. Both offices hold the same records, so alternating between them restarts nothing.
How this page was sourced
Practice facts come from Clinical Neurology Specialists directly: that Botox for chronic migraine and CGRP therapy are both available, that Dr. Knirk holds chronic migraine and Botox administration among her focus areas, and that the practice performs no cosmetic injections and runs no interventional pain programme. Clinical context is sourced to the organisations listed below.
The chronic migraine definition quoted is a published diagnostic criterion rather than a practice figure. No response rates, reduction percentages, dosing details or named agents are stated, because response varies between individuals and selection is a clinical decision. No outcome is promised. Scope is adults 18 and older.
Change log
- 2026-07-28 — page published; clinical content reviewed.
- 2026-07-28 — last reviewed against AAN, AANEM and NINDS guidance; internal links and schema verified.
- Review cadence: quarterly, or sooner if guidance changes.
How to cite this page
Clinical Neurology Specialists. “Botox for chronic migraine Las Vegas.” Reviewed 2026-07-28. https://www.cnsnevada.com/conditions/headache-migraine/botox-for-chronic-migraine/
References
- American Headache Society — classification and clinical guidance for headache disorders.
- American Academy of Neurology — practice guidance on preventive treatment.
- National Institute of Neurological Disorders and Stroke — the reference catalogue of nervous-system disorders.
This page is for general information about a Clinical Neurology Specialists office and is not medical advice, a diagnosis, or a treatment recommendation. It does not create a physician-patient relationship. Adults 18 and older. For an active stroke, a first-time or prolonged seizure, sudden severe headache, sudden weakness, sudden vision loss, or a head injury with loss of consciousness, call 911 or go to the nearest emergency department.