Therapeutic Botox
Migraine Botox is available at two clinics. Choose whichever is more convenient - you decide when you book.
If you have chronic migraine, you have probably already tried a lot. This guide explains, in plain language, what Botox for migraine actually is, who it suits, how it is done, what it costs in BC, and how it fits alongside the rest of migraine care - written by Dr. Sarah Baldwin, a family physician who provides migraine Botox and comprehensive migraine treatment in Victoria and Burnaby.
Migraine is more than a bad headache - it is a neurological condition, often with throbbing pain, sensitivity to light and sound, nausea, and sometimes aura. It becomes chronic migraine when headaches happen on 15 or more days a month for at least three months, with migraine features on at least 8 of those days. Chronic migraine is common, frequently under-treated, and it responds best to a preventive plan - one aimed at making attacks less frequent and less severe, rather than only treating each one as it arrives.
Botox (onabotulinumtoxinA) is Health Canada approved specifically for chronic migraine, and it works differently from the medication you take during an attack. It is a preventive treatment: small amounts are injected into set muscles around the head and neck, where it is understood to dampen the nerve signals that help trigger migraine. Because it works preventively, the goal is fewer and milder headache days over the following weeks, not stopping a single migraine in the moment. It does not usually eliminate migraine entirely, and Dr. Baldwin will be honest with you about what is realistic for your situation.
Botox is generally considered for people with chronic migraine who have not had enough relief from oral preventive medications, or who cannot tolerate them. You are more likely to be a good candidate if you have frequent headache days, a clear or confirmed migraine pattern, and realistic goals for preventive treatment. You do not need an existing formal diagnosis to be seen - Dr. Baldwin can assess new patients and help clarify the diagnosis. If your assessment shows a pattern that is episodic, or something other than migraine, she will point you toward the approach that fits it better rather than treating everyone the same way.
Dr. Baldwin uses the standard PREEMPT protocol - the same injection pattern Botox for chronic migraine was studied and approved under. In practice, that means a series of about 31 small injections across seven muscle areas of the forehead, temples, back of the head, neck, and shoulders, using a very fine needle. The full series takes only a few minutes, needs no freezing or downtime, and is repeated about every 12 weeks. Most people describe the injections as quick pinches. Benefit often builds over the first two or three cycles, so how well it works usually becomes clearer after a few rounds than after the first.
Botox is one tool, not the whole plan - and one of the advantages of seeing a physician who manages migraine, rather than an injector who only does the procedure, is that the rest of the plan is on the table too. As part of your care, Dr. Baldwin can:
The right combination is individual. The point of the assessment is to build yours, rather than to fit you to whichever single treatment a clinic happens to offer.
This is one of the most common questions, and the honest answer is that neither is automatically better - they work in different ways and suit different people, and some patients use them together. Because Dr. Baldwin prescribes and manages both, the choice can be made based on your history, your coverage, and how you have responded to past treatments, rather than being limited by what is available in the room.
It is worth being clear about this up front: BC PharmaCare and MSP do not cover Botox for chronic migraine - the province specifically excludes migraine from its botulinum toxin coverage. Coverage for the medication instead generally comes through extended health or private insurance, and many plans do provide it, though benefits vary. Because third-party insurance can be genuinely confusing, Dr. Baldwin works with a specialized pharmacy that helps coordinate your coverage and the medication itself, so you are not left to navigate the paperwork alone. What to expect for your own plan is reviewed at your assessment, before you commit to anything.
Migraine and chronic headache are more common in people with hypermobility spectrum disorders and EDS, often overlapping with neck instability, TMJ dysfunction, and dysautonomia. If that describes you, these overlaps are considered together in your assessment rather than treated as separate, unrelated complaints. You can read more on the EDS and hypermobility page.
Chronic migraine generally means having headaches on 15 or more days a month for at least three months, with migraine features on at least 8 of those days. It is different from episodic migraine, where attacks happen less often. Botox (onabotulinumtoxinA) is Health Canada approved specifically for chronic migraine, so part of the first visit is working out which pattern best describes yours.
Botox is generally considered for people with chronic migraine who have not had enough relief from oral preventive medications, or who cannot tolerate them. Good candidates usually have frequent headache days, a confirmed or clear migraine pattern, and realistic goals about what preventive treatment can do. Whether it fits you depends on your history, which is exactly what the assessment is for. If your pattern turns out to be episodic or something other than migraine, Dr. Baldwin will talk through the options that suit it better.
Botox is a preventive treatment, not a treatment for an attack that has already started. Small amounts are injected into specific muscles around the head and neck, where it is thought to quiet the nerve signals that help set off migraine. Because it works preventively, the aim is fewer and less intense headache days over time rather than stopping a single migraine in the moment.
Dr. Baldwin uses the standard PREEMPT protocol that Botox for chronic migraine was studied and approved under: a set series of small injections (about 31 sites across seven muscle areas of the forehead, temples, back of the head, neck, and shoulders), repeated about every 12 weeks. The full series takes only a few minutes.
The injections use a very fine needle and most people describe them as quick pinches rather than significant pain. No freezing or downtime is needed, and you can return to your day afterward.
Some people notice a change within a couple of weeks, but benefit often builds over the first two or three cycles, so how well it works usually becomes clearer after a few rounds rather than after the first. Each cycle generally lasts about 12 weeks, which is why treatment is repeated on that schedule.
The most common effects are temporary and mild, such as tenderness at the injection sites, a short-lived headache, or some neck stiffness. Less commonly, eyelid or brow drooping can occur and is temporary. Dr. Baldwin reviews the risks and what to watch for before you decide to proceed.
No. BC PharmaCare and MSP do not cover Botox for chronic migraine - the province specifically excludes migraine from its botulinum toxin coverage. Coverage for the medication generally comes through extended health or private insurance instead, which is covered in the next question.
Many extended health and private insurance plans do provide coverage for BOTOX Therapeutic for chronic migraine, although benefits vary by plan. Because third-party insurance can be complicated to navigate, Dr. Baldwin works with a specialized pharmacy that helps coordinate your coverage and the medication, so you are not left to sort out the paperwork alone. What to expect for your own plan is reviewed at your assessment.
CGRP-targeted medications (such as erenumab, galcanezumab, and fremanezumab) are a newer class of migraine preventives, given as injections or infusions, that work in a different way from Botox. Neither is automatically better - they suit different people, and some patients use them together. Dr. Baldwin prescribes and manages CGRP treatments as well as Botox, so the plan can be built around what fits your situation rather than around whichever single treatment a clinic happens to offer.
Yes. Preventive treatment like Botox is meant to work alongside the medication you take for individual attacks (such as triptans or anti-inflammatories), not to replace it. Part of the assessment is reviewing all of your medications together to make sure the overall plan makes sense.
That is a common reason people come in, and it does not rule anything out. Botox and CGRP treatments often help people who did not get enough relief from oral preventives, and part of the assessment is reviewing what you have already tried so the next step is not just more of the same.
Frequent use of acute painkillers or triptans can, over time, drive headaches to become more frequent - medication-overuse headache. It is common and treatable, and it often needs to be addressed for preventive treatment to work well. Dr. Baldwin assesses for it and helps manage it as part of the overall plan rather than treating it as a separate problem.
No referral is needed to book. You do not need an existing diagnosis either - Dr. Baldwin can assess new patients, review your history, and help clarify the diagnosis as part of the visit. If your symptoms are new, changing, or point to something that needs a neurologist, she will tell you honestly and help direct you.
Not everyone responds, and that is discussed openly. If Botox is not the right fit or does not help after a fair trial, there are other paths - adjusting or adding preventive medications, CGRP treatments, trigger point injections where neck and shoulder muscles contribute, and referral to neurology for complex cases. The goal is a plan that works, not one particular treatment.
Botox for migraine is generally not recommended in pregnancy, since it has not been established as safe for that use. If you are pregnant, trying to conceive, or breastfeeding, let Dr. Baldwin know so the plan can be adjusted to focus on options that are appropriate for you.
Migraine Botox is available at two clinics. You can book in Victoria (Hillside Medical Clinic, online) or book in Burnaby (Kensington Medical Clinic, by email) - simply choose whichever is more convenient for you.
Migraine Botox is available at two clinics - choose whichever is more convenient. The first visit is an assessment, not automatically treatment, and there is no referral needed.