General Neurology

Botox and Nerve Block Treatment for Chronic Migraine

For people with frequent, disabling headaches that have not settled with tablets, in-clinic treatments such as Botox injections and nerve blocks may help reduce how often and how badly headaches occur.

Who are these treatments for?

Most people with migraine are helped by lifestyle changes and medicines. Procedural treatments are considered when headaches stay frequent or disabling despite this, or when preventive tablets cause side effects or cannot be taken.

  • Chronic migraine: headache on 15 or more days a month, with migraine features on at least 8 of them
  • Migraine that has not improved after trying preventive medicines
  • Occipital neuralgia and headaches felt at the back of the head
  • Cluster headache and some other headache types, in selected cases

Botox for chronic migraine (PREEMPT protocol)

OnabotulinumtoxinA (Botox) is an approved preventive treatment for chronic migraine. Under the PREEMPT protocol, small doses are injected just under the skin at fixed points on the forehead, temples, back of the head, neck and shoulders.

The session takes about 15 to 20 minutes in the clinic and does not need admission. Treatment is usually repeated every 12 weeks. Benefit builds up over time, so it is usually judged after two or three treatment cycles.

Botox is used as a preventive treatment for chronic migraine. It is not a treatment for occasional migraine or for an acute headache attack.

Greater occipital nerve (GON) block

The greater occipital nerves run from the upper neck over the back of the head. In a GON block, a local anaesthetic, sometimes with a small dose of steroid, is injected near the nerve on one or both sides.

It can break a prolonged cycle of headache and may give relief that lasts days to weeks. It is used for occipital neuralgia, cluster headache and selected patients with migraine, and can be repeated when helpful.

Nerve compression in the neck and lower back

Pain, numbness or weakness that spreads into the arm or leg can come from a nerve root pressed in the spine (cervical or lumbar radiculopathy). Many patients improve without surgery.

  • Clinical examination, with MRI and nerve conduction studies when needed
  • Medicines for nerve pain and short courses of anti-inflammatory treatment
  • Physiotherapy and advice on posture and activity
  • Referral for spine procedures or surgery when weakness or other findings call for it

What happens at the first visit?

The first visit includes a detailed headache history and a neurological examination. A headache diary for the previous month helps confirm the headache type and how often it occurs. Scans are advised only if warning signs or examination findings suggest another cause.

Previous treatments, medicine doses and painkiller use are reviewed, because overuse of painkillers can itself make headaches more frequent.

Side effects and safety

Both treatments are generally well tolerated. Possible side effects of Botox include neck pain or stiffness, brief injection-site discomfort and, uncommonly, a drooping eyelid or eyebrow that settles with time. Nerve blocks can cause brief soreness, dizziness or numbness at the injection site.

  • Botox is not given during pregnancy or breastfeeding
  • Tell the doctor about blood-thinning medicines, allergies and any neuromuscular condition such as myasthenia gravis

When should someone seek urgent care?

  • A sudden, severe headache that peaks within a minute
  • Headache with fever, stiff neck, confusion or a rash
  • Headache with weakness, numbness, speech difficulty or vision loss

For these warning signs, call 108 or go to the nearest emergency department.

FAQs

Frequently asked questions

Is Botox for migraine the same as cosmetic Botox?
It is the same medicine, but the dose, injection points and purpose are different. For chronic migraine it is given under a set medical protocol (PREEMPT) to prevent headaches.
Will I be able to stop my migraine tablets?
Some patients need fewer medicines once headaches become less frequent, but this varies. Any change to medicines should be made with your doctor.
Does a nerve block hurt?
It uses a fine needle and a local anaesthetic, so most people feel only a brief sting. You can usually go home soon after.
Am I suitable for these treatments?
That is decided after a consultation, based on your headache type, how often it occurs, treatments already tried and your overall health.

Open Mon–Sat, 9AM–5PM

Book a consultation

Request an appointment for migraine or headache treatment at KIMS Hospitals (New Facility), Kondapur, or call the clinic. Bring previous prescriptions, scan reports and a list of your current medicines.

Request appointment

Choose a day from Monday to Saturday. The clinic calls back to confirm your time.

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Clinic hoursMon–Sat, 9AM–5PM9AM5PM
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