Chronic Migraine Botox Eligibility Check
Five questions, about two minutes. It walks the FDA label for Botox in chronic migraine and the prior-authorization criteria most commercial plans apply, then tells you the right next step. Nothing you enter leaves your browser.
Before you start
What this check does
Botox (onabotulinumtoxinA) is FDA-approved to prevent headaches in adults with chronic migraine, and commercial plans authorize it against a short list of criteria. This check asks for the same facts the authorization is built on. Have your headache diary or calendar app open if you keep one — the day counts matter more than anything else.
This is an eligibility screen, not a diagnosis. Chronic migraine is diagnosed at the consultation, and coverage is decided by your plan.
Question 1 of 6
Does any of these describe your headaches?
Tick any that apply. These are the headaches that need urgent evaluation rather than a screening tool.
Question 2 of 6
Are you 18 or older?
Question 3 of 6
Over the last three months, on how many days a month have you had a headache of any kind?
Count every day with any headache, mild or severe, treated or not. If you keep a diary, use the average of the last three months.
Question 4 of 6
On at least 8 of those days a month, does the headache have migraine features?
Migraine features: pain on one side or throbbing, moderate to severe, worse with routine activity, with nausea or sensitivity to light and sound, or with an aura beforehand — or a headache that a triptan reliably stops.
Do your headaches last 4 hours or longer when untreated?
Question 5 of 6
Which preventive (daily or monthly) medications have you tried for at least two months?
Tick every class you have tried. Rescue medications taken during an attack — triptans, NSAIDs, Excedrin — do not count here.
Question 6 of 6
On how many days a month do you take something for a headache?
Triptans, NSAIDs, acetaminophen, Excedrin, combination pills, or opioids — count the days, not the doses.
Your result
Educational screen, not a diagnosis or a coverage decision. Chronic migraine is diagnosed at the consultation and coverage is determined by your plan after prior authorization.
The criteria, in plain terms
Botox™ (onabotulinumtoxinA) carries an FDA indication for the prevention of headaches in adults with chronic migraine — headache on 15 or more days a month, lasting four hours or longer. The International Classification of Headache Disorders adds the second half of the definition: the pattern has lasted more than three months, and on at least 8 days a month the headache has migraine features or responds to a triptan (ICHD-3, 2018). The PREEMPT trials that established the treatment enrolled exactly this population, 1,384 adults, and at 24 weeks Botox reduced headache days by 8.4 a month against 6.6 with placebo, a difference that grew across cycles (Dodick 2010). About two-thirds of those patients were overusing acute medication at baseline, which is why medication overuse is addressed alongside treatment rather than used to exclude anyone.
Commercial plans add the payer step. Most require documented trials of at least two oral preventive classes — a beta-blocker, an anticonvulsant, an antidepressant, sometimes an ARB or calcium-channel blocker — at an adequate dose for two to three months each, that failed or were not tolerated. Some plans require three. Some now count a CGRP-targeting antibody or gepant as a qualifying trial, which follows the American Headache Society's 2024 position that CGRP-targeting therapies are first-line preventives rather than last resorts (Charles 2024). Continuation after the first two or three cycles usually requires a documented drop in headache days. Plans differ in the details, so the office submits the authorization with your diary and medication history after the consultation, and we never ask you to guess.
Two things the check cannot do. It cannot tell you whether your 15 headache days are migraine, cervicogenic headache from the neck, occipital neuralgia, or medication-overuse headache sitting on top of any of them — that is the examination, and it changes the procedure. And it cannot tell you what your plan will pay. What it can do is tell you, in two minutes, whether the Botox conversation is the right one to have, and get you to the right next step.
What happens at the visit
The consultation with Dr. Alex Movshis, dual board-certified in Anesthesiology and Pain Medicine, is 45 minutes. Bring your headache diary, your full preventive-medication history with doses and durations, and any prior imaging. The exam separates migraine from the headaches that mimic it, especially the ones that start at the base of the skull — the cervicogenic headache film shows why that matters. If chronic migraine is confirmed and the criteria are met, prior authorization is submitted the same day and typically takes 7–14 business days, and the first session is generally scheduled within 2–3 weeks. The session is the fixed 155-unit, 31-site PREEMPT protocol described on our Botox for chronic migraine page and shown in the 72-second mechanism film, repeated every 12 weeks. Self-pay pricing for the protocol is published. We do not participate with Medicare or Medicaid.
References
- Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. doi:10.1177/0333102417738202
- Dodick DW, Turkel CC, DeGryse RE, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50(6):921–936. doi:10.1111/j.1526-4610.2010.01678.x
- Ailani J, Burch RC, Robbins MS. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021–1039. doi:10.1111/head.14153
- Charles AC, Digre KB, Goadsby PJ, Robbins MS, Hershey A. Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update. Headache. 2024;64(4):333–341. doi:10.1111/head.14692
- U.S. Food and Drug Administration. BOTOX (onabotulinumtoxinA) prescribing information, BLA 103000. Drugs@FDA
Botox for Migraines: Eligibility Questions
Adults with chronic migraine: headache on 15 or more days a month for more than three months, with migraine features (one-sided or throbbing pain, worse with activity, nausea, light or sound sensitivity, or aura) on at least 8 of those days, and headaches that last four hours or longer. That is the FDA-approved indication and the ICHD-3 definition. Botox is not approved for episodic migraine (fewer than 15 headache days a month), and most plans will not cover it for that pattern. A headache diary for the prior 1–3 months is the single most useful thing to bring, because the day counts are what the authorization is built on.
Most commercial plans require documented trials of at least two oral preventive medications from different classes — typically a beta-blocker (propranolol, metoprolol, timolol), an anticonvulsant (topiramate, divalproex), or an antidepressant (amitriptyline, nortriptyline, venlafaxine) — at an adequate dose for at least two to three months each, that either did not work or were not tolerated. Some plans require three, some count a CGRP antibody or gepant as a trial, and some accept a documented contraindication in place of a trial. Plans differ, which is why we submit the authorization for you after the consultation rather than asking you to guess. If you have not completed two trials, the visit can start and document them, or you can choose self-pay Botox without the payer step.
No. Taking acute medication (triptans, NSAIDs, acetaminophen, combination analgesics) on 10 or more days a month is called medication-overuse headache, and it was present in about two-thirds of the patients in the PREEMPT trials that established Botox for chronic migraine — they still responded. It does not exclude you from treatment. It does need to be addressed at the same time, because overuse keeps the headache frequency high on its own, and we plan the taper alongside the injections.
Then the pattern is episodic migraine, and Botox is not the right preventive under the label or under most plans. The options that are: CGRP-targeting preventives (the monoclonal antibodies erenumab, fremanezumab, galcanezumab, eptinezumab, or the oral gepants atogepant and rimegepant), which the American Headache Society now lists as first-line preventives alongside the older oral classes, and the interventional procedures for the headaches that are not migraine at all — an occipital nerve block for occipital neuralgia, a third occipital nerve block and radiofrequency ablation for cervicogenic headache from the neck. The consultation sorts which one you have.
After the consultation our office submits the prior authorization with your headache diary, diagnosis, and medication history. Approval typically takes 7–14 business days, and the first injection session is generally scheduled within 2–3 weeks of the visit. The session itself is the fixed PREEMPT protocol — 155 units across 31 small injections in seven muscle groups of the head and neck — takes about 15 minutes, and is repeated every 12 weeks. Benefit builds over the first two or three cycles.
No. This check runs entirely in your browser. There is no form, no server, and nothing is stored after you leave the page. The only thing recorded is that a check was completed and whether it ended with a suggestion to book, so we know the tool is being used.