Botox for Chronic Migraine in Delhi: Treatment, Cost & What to Expect
Chronic migraine can affect work, sleep, concentration, social activity and overall quality of life. For appropriately selected adults, BOTOX® (onabotulinumtoxinA) is an established preventive treatment designed to reduce the frequency and overall burden of chronic migraine.
Migraine BOTOX® is not simply cosmetic Botox given at additional sites. It follows a medical treatment pattern involving defined areas of the head and neck, substantially higher total dosing and structured follow-up.
At The Face Clinic in Hauz Khas, South Delhi, treatment begins with clinical assessment rather than simply injecting the area in which pain is felt. The first question is whether the headache pattern is consistent with chronic migraine and whether onabotulinumtoxinA is an appropriate preventive option.
BOTOX® may reduce migraine burden in patients who respond, but it does not cure migraine, and individual outcomes vary.
Medically reviewed by: Dr. Reema Arora, MBBS, MSc Facial Aesthetics (UK)
Founder & Medical Director, The Face Clinic, Hauz Khas, New Delhi
Last medically reviewed: September 2026
Founder & Medical Director, The Face Clinic, Hauz Khas, New Delhi
Last medically reviewed: September 2026
Important: This guide is intended for patient education. Chronic migraine is a neurological diagnosis, and this information does not replace individual medical or neurological assessment.
BOTOX® for Chronic Migraine at a Glance
Clinical Question | Evidence-Based Overview |
|---|---|
Who is treatment intended for? | Adults with appropriately diagnosed chronic migraine |
What is chronic migraine? | Headache on ≥15 days/month for >3 months, with migraine features on ≥8 days/month |
Established PREEMPT dose range | 155–195 Units |
Established PREEMPT injection pattern | 31–39 sites across defined head and neck regions |
Individualised clinic planning range | 120–220 Units in selected patients, according to clinical assessment and treatment plan |
Typical treatment interval | Approximately every 12 weeks |
Treatment objective | Reduce migraine frequency, severity and overall burden—not cure migraine |
Indicative clinic cost | ₹50,000–₹90,000 per treatment session |
Important dose distinction: The strongest established clinical evidence for chronic migraine relates to the 155–195 Unit PREEMPT protocol. A dose outside that range represents individualised clinical dosing rather than the standard PREEMPT regimen and should be selected only when medically appropriate.
What Is BOTOX® Treatment for Chronic Migraine?
BOTOX® is the brand name for onabotulinumtoxinA, a botulinum toxin type A preparation used for several medical as well as aesthetic indications.
In chronic migraine, its role is preventive. It is not intended to stop an individual migraine attack once it has started. Instead, treatment aims to reduce the frequency and overall burden of future headaches over repeated treatment cycles.
India’s Central Drugs Standard Control Organisation records an additional indication for botulinum toxin type A 50-Unit and 100-Unit vials for the prophylaxis of headaches in adults with chronic migraine.
This medical application is fundamentally different from cosmetic Botox treatment in Delhi, where substantially smaller doses are typically directed at selected facial muscles to soften expression-related lines.
Who May Be Suitable for Migraine BOTOX®?
BOTOX® may be considered for adults who have been appropriately assessed as having chronic migraine.
According to the ICHD-3 definition of chronic migraine, chronic migraine involves headache occurring on 15 or more days per month for more than three months, with migraine features present on at least eight days per month.
That distinction matters.
A person may experience severe and disabling migraine without meeting the criteria for chronic migraine, and treatment should not be selected simply because headaches are frequent, painful or located around the forehead or temples.
Assessment should consider:
- headache frequency;
- migraine characteristics;
- duration of the problem;
- current and previous preventive treatment;
- acute medication use;
- relevant medical history; and
- whether another cause of headache needs consideration.
Where the diagnosis is uncertain, symptoms are atypical, the headache pattern has changed significantly or neurological evaluation is otherwise clinically indicated, specialist assessment may be recommended before treatment.
Chronic vs Episodic Migraine
Chronic migraine and episodic migraine are not interchangeable terms.
Someone with episodic migraine may experience several severe attacks every month but still have fewer than 15 headache days per month.
The strongest evidence and established treatment framework for onabotulinumtoxinA relates specifically to chronic migraine.
Patients with episodic migraine may still require preventive treatment, but the appropriate option should be determined according to their diagnosis and individual medical circumstances rather than automatically applying the chronic-migraine BOTOX® protocol.
What About Frequent Painkiller or Triptan Use?
Frequent use of acute headache medicines can complicate chronic migraine and may contribute to medication-overuse headache in some patients.
For that reason, assessment should include:
- how many days per month acute medication is taken;
- the type of medicine used;
- whether medication use has been increasing; and
- whether withdrawal or adjustment forms part of the overall migraine-management plan.
Medication overuse does not automatically mean that BOTOX® cannot be used, but it should be recognised and managed as part of the wider treatment strategy.
Migraine Triggers Are Not the Same as the Cause of Migraine
Migraine is a neurological disorder rather than simply a reaction to stress, food, muscle tension or lack of sleep.
However, individual attacks may be influenced by triggers such as:
- disrupted sleep;
- stress;
- missed meals;
- dehydration;
- hormonal changes;
- alcohol; or
- particular sensory stimuli.
Avoiding a recognised trigger may help some patients, but chronic migraine generally requires a broader medical approach.
Trigger management should therefore complement—not replace—appropriate diagnosis and preventive treatment where indicated.
How Does BOTOX® Help Prevent Chronic Migraine?
The migraine effect of onabotulinumtoxinA cannot be explained simply as “relaxing tense muscles.”
After injection, BOTOX® interferes with the release of signalling molecules involved in peripheral pain transmission. This can reduce activation of pain pathways associated with migraine and, over time, decrease migraine frequency and burden in patients who respond.
Muscle relaxation can occur because of the way botulinum toxin acts at the neuromuscular junction, but chronic-migraine treatment is not simply cosmetic Botox performed at different sites.
That distinction is important because many patients are already familiar with Botox for facial lines and may assume the two treatments are essentially the same.
The PREEMPT BOTOX® Protocol for Chronic Migraine
The best-established chronic-migraine injection framework comes from the PREEMPT clinical programme.
Treatment follows a structured anatomical injection pattern rather than placing injections only where the patient happens to feel pain on the day of treatment.
How Many Units of BOTOX® Are Used for Chronic Migraine?
The standard fixed-dose treatment uses:
155 Units of BOTOX® across 31 fixed injection sites.
The broader PREEMPT treatment paradigm allows:
155–195 Units across 31–39 sites approximately every 12 weeks.
Under the additional “follow-the-pain” component of the PREEMPT paradigm, up to 40 further Units may be distributed across selected temporalis, occipitalis and/or trapezius sites, taking the total to a maximum of 195 Units across 39 sites.
This 155–195 Unit range has the strongest established clinical evidence for chronic migraine.
At The Face Clinic, however, the total dose may be individualised within a broader 120–220 Unit clinical planning range in selected patients, according to the diagnosis, anatomy, treatment history, previous response, pattern of symptoms and the treating doctor’s clinical judgement.
The two concepts should not be confused:
- 155–195 Units = established PREEMPT evidence-based range;
- 120–220 Units = The Face Clinic’s broader individualised clinical planning range where medically appropriate.
BOTOX® Units are product-specific and should not be assumed to be equivalent to, or directly convertible into, units of another botulinum toxin preparation.
Where Are Migraine BOTOX® Injections Given?
The fixed PREEMPT protocol distributes treatment across seven defined head and neck muscle regions:
- corrugator;
- procerus;
- frontalis;
- temporalis;
- occipitalis;
- cervical paraspinal muscle group; and
- trapezius.
The fixed treatment pattern comprises 31 injection sites, generally using 5 Units at each site.
Additional protocol-defined sites may be used in selected regions as part of the follow-the-pain approach.
This is why migraine BOTOX® should not be reduced to the idea of treating a few forehead, scalp or temple “trigger points.”
How Often Is BOTOX® Repeated for Chronic Migraine?
The established retreatment interval is approximately every 12 weeks.
Treatment response should be assessed over time rather than assuming that one session will determine whether therapy ultimately works.
Some patients respond after the first treatment cycle, while others may require additional cycles before the response becomes sufficiently clear.
How Effective Is BOTOX® for Chronic Migraine?
The pivotal PREEMPT programme studied 1,384 adults with chronic migraine.
At 24 weeks, patients receiving onabotulinumtoxinA experienced an average reduction of 8.4 headache days per 28-day period, compared with 6.6 days in the placebo group.
Approximately 47.1% of patients receiving onabotulinumtoxinA achieved at least a 50% reduction in headache days, compared with approximately 35.1% receiving placebo.
These figures are study averages rather than predictions for an individual patient.
They also illustrate an important point: chronic migraine trials have a meaningful placebo response, so treatment should not be presented as a guaranteed or dramatic cure.
The clinically relevant question is whether BOTOX® produces a meaningful reduction in headache burden, disability, severity and/or medication use for the individual patient.
What Results Can Patients Realistically Expect?
For patients who respond, treatment may lead to:
- fewer headache or migraine days;
- reduced severity of some headaches;
- shorter or less disabling attacks in some patients;
- reduced reliance on acute medication in some cases;
- improved ability to work or carry out normal activities; and
- improved overall quality of life.
Not every patient responds adequately.
Someone who continues to experience migraine after treatment may still have achieved a clinically meaningful benefit if the number of headache days, severity or disability has decreased.
The objective is therefore reduction in migraine burden, not a promise of being pain-free or migraine-free.
How Is Treatment Response Measured?
A headache diary is one of the most useful ways of assessing response.
Patients may be asked to track:
- total headache days;
- migraine days;
- severity;
- acute medication use;
- duration of attacks; and
- effect on work and normal activities.
The European Headache Federation consensus guideline uses a reduction of less than approximately 30% in headache days as one definition of non-response, while also recognising that headache intensity, disability and patient preference matter.
Response should generally be assessed across the first two to three treatment cycles, rather than automatically judging treatment after one session.
Whether therapy is continued should therefore depend on measurable clinical benefit, tolerability and the patient’s overall migraine burden.
How Quickly Does Migraine BOTOX® Work?
BOTOX® is a preventive treatment rather than an immediate pain-relieving injection.
Some patients begin to notice improvement during the weeks following the first treatment cycle, while others require repeated treatment before the benefit becomes sufficiently clear.
Patients should therefore avoid judging the procedure within the first few days.
Where treatment is continued, repeat sessions are generally planned at approximately 12-week intervals, subject to clinical response and medical assessment.
Side Effects and Safety of BOTOX® for Chronic Migraine
BOTOX® treatment for chronic migraine is generally well tolerated in appropriately selected patients, but it is a medical treatment and has recognised adverse effects, precautions and contraindications.
Possible treatment-related effects include:
- injection-site discomfort or bruising;
- neck pain;
- temporary muscle weakness;
- eyelid drooping;
- headache; or
- temporary worsening of migraine in some patients.
Rare but potentially serious adverse effects associated with botulinum toxin products are also described in the official BOTOX® prescribing information.
Patients should seek prompt medical assessment if significant difficulty swallowing, speaking or breathing develops after treatment.