Botox for Chronic Migraine: Insurance Coverage, Prior Authorization, and What to Expect
Living with chronic migraine can be unpredictable, exhausting, and frustrating—especially when headaches continue despite medications. Botox offers a proven and well-tolerated treatment option that can reduce headache frequency and improve quality of life. While many people have heard about Botox for migraine, most aren’t sure how it works, how to access it, or whether insurance will help cover it.
As a neurologist who treats patients with migraine, I hear these questions daily. Below is a simple, patient-friendly guide to how Botox works clinically, how insurance coverage usually works, and what to expect if you’re considering treatment.
Who is Botox for?
Botox (onabotulinumtoxinA) is FDA-approved for chronic migraine, which means:
headaches on 15 or more days per month, and
at least 8 of those days with migraine features, and
this pattern continues for 3 months or more
If you’re unsure whether you meet this criteria, you’re not alone—many patients haven’t tracked their headache days before seeing a specialist. Part of our first visit includes helping you sort this out.
How Botox helps chronic migraine
Botox doesn’t relax wrinkles in migraine treatment—it works on pain pathways by blocking neurotransmitter release and reducing sensitization. This can lessen both:
headache frequency
headache intensity
Botox is given every 12 weeks using a standardized injection pattern across the forehead, temples, scalp, and neck. Most people begin to notice improvement after the second treatment cycle, and benefits often increase over time.
Is Botox covered by insurance?
In many cases, yes—Botox is covered for chronic migraine when patients meet clinical criteria. However, most insurance plans require a process called prior authorization before treatment begins.
This doesn’t mean Botox is experimental. It simply means the insurer needs documentation confirming that it is medically necessary.
What is prior authorization?
Prior authorization (PA) is a request sent to your insurance that includes:
migraine diagnosis
headache frequency
prior medications tried
treatment response
clinical notes
Insurance plans review this information to confirm eligibility before approving coverage.
Do I have to try other migraine medications first?
Most insurers require that patients have tried other preventive medications before approving Botox. This is called step therapy, and may include:
beta blockers
anti-seizure medications
antidepressants
CGRP blockers/antagonists
or other preventive therapies
If you’ve already tried some of these—or couldn’t tolerate them—that information actually helps with authorization.
How long does authorization take?
Approval timelines vary by insurer. Many authorizations are completed in 2–6 weeks. Once approved, treatment can begin and is typically repeated every 3 months.
What if insurance doesn’t cover it?
Not all plans cover Botox, and some approvals may be partial or denied. If that happens, alternative pathways—including payment plans or membership models—can allow patients to continue treatment if they are benefiting.
What to expect during treatment
Botox treatment for migraine:
takes about 10–15 minutes
uses a very small needle
requires no downtime
allows you to resume normal activity immediately
My goal is to make the experience as comfortable as possible. Many patients are surprised by how quick and straightforward the appointment is.
Insurance acceptance (credentialing in progress)
Our clinic will begin accepting insurance for chronic migraine Botox. Credentialing with major insurers is currently in progress. If you would like to be notified when we begin scheduling patients through insurance, you can join our waitlist below.
Join the waitlist
Patients on the waitlist receive:
priority scheduling
insurance eligibility updates
authorization guidance
next-step instructions
Click Here to Join the Chronic Migraine Waitlist
Final thoughts
Botox is not a last resort for migraine—it’s a well-established, evidence-based treatment that may offer meaningful improvement for people living with chronic migraine. If migraines are interfering with work, family, sleep, or activities you enjoy, it may be worth exploring whether Botox is right for you.