Medical Botox: Chronic Migraine and Excessive Sweating (Hyperhidrosis)

Why Botox can be “medical”

Botulinum toxin temporarily blocks acetylcholine release at the nerve terminal. Beyond mimetic muscle, this affects neurotransmitter release in pain pathways and sympathetic fibres driving sweat glands — hence two licensed medical indications.

1) Chronic migraine

Who is indicated?

Chronic migraine: 15+ headache days/month, at least 8 migrainous, for over 3 months. In episodic migraine (<15 days) Botox is not routinely recommended.

PREEMPT protocol

The evidence standard from the PREEMPT trials: 155 units across 31 fixed sites in 7 head/neck muscle groups (frontalis, corrugator, procerus, temporalis, occipitalis, cervical paraspinal, trapezius), repeated every 12 weeks. Response may be limited in the first 1–2 cycles; real assessment is usually after the 2nd session.

What to expect

The goal is reducing headache-day frequency and severity, not eliminating headache. Responders typically reduce acute medication use markedly. This is a shared neurology–aesthetics follow-up; neurology confirmation of diagnosis matters.

2) Excessive sweating (hyperhidrosis)

Diagnosis and test

Primary focal hyperhidrosis most often affects the underarms, palms and soles. Before treatment the Minor (starch–iodine) test maps the sweating area: the zone turns blue-purple and injection points are marked accordingly.

Dose and zone

Palmar treatment can cause temporary grip weakness; discussed in advance for manual workers. Palms/soles can be painful, so regional anaesthesia/cooling is used.

What to expect

Axillary treatment has high satisfaction; most patients are dry within days. It controls sweating to a medical threshold without endangering thermoregulation, as only local glands are affected.

How it differs from cosmetic Botox

• Much higher dose (migraine 155 U, axillae 100–200 U; cosmetic upper face typically 30–60 U).
• Different, indication-specific mapping.
• Diagnosis confirmation (neurology/dermatology) is a prerequisite.

Safety / who is unsuitable

• Not performed in pregnancy/breastfeeding.
• Neuromuscular junction disorders (myasthenia gravis, Lambert-Eaton) are contraindications.
• Deferred if there is active infection at the site.
• See our complication-management page for expectation and risk handling.

FAQ

“Is migraine Botox addictive?” No. When the effect wanes the picture returns to baseline; there is no dependence.

“Will sweating stop completely?” The aim is below the social/functional threshold, not total dryness. Daily life eases markedly for most.