A clinical case highlights how Botox can provide meaningful relief for patients with treatment-resistant chronic migraines. A 46-year-old woman presented with a five-year history of migraines occurring 20–25 days per month, accompanied by nausea, light sensitivity, and cognitive fog.
She had previously tried multiple oral preventive medications with limited success. A CGRP monoclonal antibody provided mild early improvement, but migraine frequency and severity returned within months. Acute rescue medications remained necessary, and daily functioning was significantly impaired.
A comprehensive reassessment revealed neck and jaw muscle tenderness, bruxism, and signs of central sensitization, factors commonly associated with chronic migraine. Based on these findings, Botox treatment was initiated using the standard chronic migraine protocol.
After one treatment cycle, migraine days decreased to approximately 14 per month, with reduced intensity. After two cycles, migraine frequency declined
further to 8–9 days per month, along with improved sleep and reduced medication use. After three cycles, sustained improvement was achieved at 6–8 migraine days per month, with significant functional recovery.
This case demonstrates that CGRP therapy failure does not predict Botox failure. Botox’s ability to target multiple migraine mechanisms allows patients to achieve relief even after other treatments fall short. For many chronic migraine sufferers, Botox represents a renewed opportunity for long-term improvement.
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