OnabotulinumtoxinA is thought to reduce migraine by blocking the release of pain-signalling chemicals from nerve endings around the head and neck, dampening the signals that drive migraine. It is injected at fixed points across the forehead, temples, back of the head, neck and shoulders.
OnabotulinumtoxinA is thought to reduce migraine by blocking the release of pain-signalling chemicals from nerve endings around the head and neck, dampening the signals that drive migraine. It is injected at fixed points across the forehead, temples, back of the head, neck and shoulders.
In cosmetic use, botulinum toxin works by relaxing muscle. Its effect in migraine is understood differently: it appears to interfere with the release of chemical messengers involved in transmitting pain from nerve endings, reducing the input that sensitises the pain pathways involved in migraine. That is why it is preventive rather than something that helps an attack in progress, and why muscle relaxation is not the point of the treatment even though it may occur.
The treatment follows a defined pattern of injection sites across the forehead, temples, the back of the head, the neck and the upper shoulders. The pattern is standardised rather than improvised, which is part of why it should be given by someone trained in it specifically. Some sites can be adjusted between rounds if a particular one caused a troublesome effect, such as an eyebrow sitting unevenly.
The effect wears off, which is the reason treatment is given on a repeating cycle rather than once. That also means unwanted effects are self-limiting. Over time the decision to continue is reviewed against measured response, so counting headache days matters as much here as anywhere in migraine care. Injections are given in the office at either location; this practice performs no surgery and operates no infusion suite.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: National Institute of Neurological Disorders and Stroke; American Academy of Neurology; MedlinePlus, National Library of Medicine.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.