migraine
Migraine is a primary neurovascular headache disorder , Characterized by recurrent moderate-to-severe throbbing headaches.
Our physician’s Real Migraine Patient Cases
Real-world cases for this condition are currently being compiled and updated. All cases are drawn from actual clinical records at Luowei Medical Aesthetics Clinic, with signed written Media Release Forms from each patient. Complete case materials are available for review with our physician during your consultation.
What is migraine? Why is it different from an ordinary headache?
Migraine is a primary neurovascular headache disorder, Characterized by recurrent moderate-to-severe throbbing headaches, often accompanied by photophobia, phonophobia, nausea, and vomiting — significantly impairing both work and daily life.chronic migraine(≥ 15 headache days per month, of which ≥ 8 meet migraine criteria, sustained for ≥ 3 months) is the indication for Botox® that is dual-approved by both NMPA and the FDA — this is not a cosmetic application; it is formal neurological treatment.
Why can’t migraine be managed the same way as a regular headache?
Ordinary tension-type headache typically responds to NSAIDs, whereas migraine involves trigeminovascular system abnormal activation, where standard pain relievers become ineffective — or worse, contribute to medication-overuse headache (MOH).
Why does Botox® work for migraine?
Botox by inhibiting peripheral trigeminal nerve terminals By inhibiting the release of pain-sensitizing neuropeptides such as CGRP and Substance P, Botox® reduces central sensitization, decreasing both the frequency and intensity of migraine attacks — this is a preventive therapy, not an acute rescue medication.
Why is it important to rule out other headache types first?
Clinically, approximately 25–30% of patients who self-report “migraines” are found on assessment to have tension-type headache, cervicogenic headache, sinus-related headache, or medication-overuse headache.Administering Botox® without subtype classification is ineffective, our physician’s first step is always a headache diary review and diagnostic classification.
Why must this be performed by a physician?
PREEMPT 31 The injection protocol involves multiple anatomically high-risk muscle groups — including the frontalis, corrugator supercilii, temporalis, occipitalis, splenius capitis, and trapezius. Depth, dosage, and angle all require formal medical training. This is not a procedure that can be safely performed by a technician.
Clinical note:Many patients have been told elsewhere that “a few Botox® injections in the forehead will treat your headaches” — only to find the treatment ineffective, and to develop brow ptosis or a stiff expression as a result. This is a predictable consequence of reducing the PREEMPT protocol to cosmetic Botox® dosing. Our physician’s migraine Botox® Strictly follows the PREEMPT standard 31-point protocol, No cosmetic objectives mixed in. No shortcuts taken.
The five major migraine triggers — it’s not just “stress”
Migraine is Genetic predisposition + multiple triggering factors the cumulative result of multiple contributing factors. Identifying your triggers is a prerequisite for successful treatment.
1. Genetic factors and neural sensitization
Those with a positive family history have a 3–4 times higher incidence than the general population. A lower central nervous system threshold for stimuli and heightened vascular reactivity form the fundamental physiological basis of migraine.
2. hormonal fluctuations
Women are three times more likely to experience migraines than men. Drops in estrogen — during the premenstrual phase and perimenopause — are well-established migraine triggers. This is why Menstrual-related migraine“mechanism.
3. neck and shoulder muscle tension / workstation posture
Prolonged computer use and sustained downward neck flexion from phone use create chronic tension in the splenius capitis and trapezius muscles, activating the greater occipital nerve and triggering or worsening migraines. This pattern is particularly common among professionals in IT, design, and finance.
4. Bruxism / TMJ dysfunction
Bruxism causes sustained contraction of the masseter and temporalis muscles, often presenting as throbbing temporal headache upon waking. Neurological medications alone tend to offer limited relief for these patients, and combined masseter + temporalis Botox®.
5. Sleep / dietary / environmental triggers
Known triggers include insufficient or excessive sleep, caffeine withdrawal, alcohol (particularly red wine), chocolate, aged cheese, MSG, bright light, and barometric pressure changes.headache diary is the gold standard for identifying individual triggers.
4 Types of headache commonly confused with migraine — key differential diagnosis points
Misclassification leads to ineffective treatment. The table below outlines the 4 most common differential diagnoses encountered in our physician’s clinical practice.
Tension-Type Headache
Tension-Type Headache · TTH
| nature | Pressure / tightening sensation · bilateral |
|---|---|
| intensity | mild to moderate |
| associated symptoms | No photophobia or phonophobia · No nausea |
| triggers | stress · neck and shoulder tension |
| first-line treatment | Relaxation therapy + modified Botox® protocol |
Cervicogenic headache
Cervicogenic Headache · CGH
| nature | unilateral · originating at the occiput and radiating forward |
|---|---|
| intensity | moderate |
| associated symptoms | restricted neck range of motion · trigger point tenderness |
| triggers | cervical spine mechanical dysfunction · posture |
| first-line treatment | physiotherapy + targeted Botox® |
Cluster Headache
Cluster Headache
| nature | severe unilateral periorbital pain · described as drilling or boring |
|---|---|
| intensity | extremely severe (suicidal headache) |
| associated symptoms | Ipsilateral tearing · nasal congestion · pupillary changes |
| triggers | alcohol · seasonal cluster pattern |
| first-line treatment | Neurology referral recommended · Botox® is not the primary indication |
Medication-overuse headache
Medication Overuse Headache · MOH
| nature | Daily persistent headache |
|---|---|
| intensity | moderate |
| associated symptoms | Worsens in the morning · Brief relief after acute medication |
| triggers | Acute rescue medication use ≥10–15 days per month |
| first-line treatment | medication withdrawal + bridging therapy + prevention |
⚠️ Warning:Clinically, 25–30% of patients who present requesting Botox® for migraine are reclassified — after a headache diary review and physical examination — as having tension-type headache, cervicogenic headache, or medication-overuse headache (MOH). Inaccurate diagnosis leads to treatment failure, which leads to repeated clinic visits — this is the single greatest frustration for patients living with chronic headache.red-flag warning signs(Sudden severe headache, focal neurological signs, morning vomiting, or fever require immediate referral to the emergency department or a neurologist — Botox® should not be administered without prior medical clearance.
Why does migraine Botox® for Asian faces require specialized anatomical adjustments?
Blind spots in mainstream North American clinics
The dosing and injection points of the North American PREEMPT protocol are derived from clinical trials conducted predominantly in Caucasian populations. Asian faces differ muscle volume, craniofacial bone proportions, and subcutaneous fat distribution in meaningful ways; directly applying the same protocol without adjustment leads to two specific problems:
- ✗ Excessive frontalis dosing → brow ptosis / heavy eyelids— The frontalis muscle is typically thinner in Asian patients; standard dosing risks unwanted spread
- ✗ temporalis injection point repositioning— The temporal fossa is typically deeper in Asian patients; fixed-coordinate injection risks incorrect tissue plane placement
- ✗ Masseter / cervical-shoulder co-treatment overlooked— Among Asian migraine patients, co-occurrence of bruxism and neck/shoulder pain is notably high
Our physician’s Asian facial anatomy specialist adjustments
| parameters | North American standard | Asian-specific adjustments |
|---|---|---|
| frontalis dose per injection point | 5 U | 3-4 U fine-tuning |
| temporalis muscle placement | fixed-coordinate injection | individualized palpation-guided placement |
| injection depth | consistent | muscle-by-muscle, layer-by-layer approach |
| masseter co-treatment | not included in the PREEMPT protocol | mandatory addition for bruxism patients |
| cervical-shoulder co-treatment | optional | IT / essential add-on for sedentary patients |
Key differentiators:Our physician specialises in treating Asian patients in Nanjing. Migraine Botox® is not simply “injecting 31 points by the diagram” — it is anatomy assessment + palpation + individualized protocol.
6 treatment approaches for migraine — matched to your subtype
Botox is a preventive treatment for chronic migraine, but it is not a standalone solution. Based on your headache diary and subtype classification, we combine it with the following therapies.
Botox(Botulinum toxin type A) PREEMPT protocol
31 -point standard injection protocol — globally recognized as gold-standard preventive treatment for chronic migraine. NMPA Dual-approved indication. Our physician administers the protocol in strict accordance with PREEMPT clinical trial standards.
Dysport(alpha-toxin neuromodulator)
an alternative option with slightly broader diffusion, suitable for large muscle groups(combined neck and shoulder treatment). Dose conversion requires clinical experience; Our physician switches to Dysport® for patients who do not tolerate Botox® well.
Xeomin(complexing protein-free neuromodulator)
free of complexing proteins, suitable for Prolonged use may lead to antibody formation patients. Among the three available botulinum toxins, Botox® has the strongest evidence base for migraine; Dysport® and Xeomin® are used as clinically informed alternatives.
Masseter Botox® (bruxism-triggered subtype)
Nighttime teeth grinding is a well-recognized migraine trigger. Botox® injected into the masseter reduces its contractile force, which in turn decreases morning temporal headaches. For patients presenting with both bruxism and migraine, our physician clinically masseter injection points added as required.
Cervical/shoulder Botox® (neck and shoulder pain-triggered subtype)
Botox® injections into the trapezius, levator scapulae, and splenius capitis muscles relieve chronic workstation-related tension — particularly beneficial for patients in IT, design, and finance roles who also experience migraines.Non-PREEMPT injection points used, however, clinical evidence supports its use as a complementary treatment.
Lifestyle modification + medication management (coordinated outside the clinic)
Headache diary / sleep hygiene / caffeine management / acute medication protocols — co-managed with your family physician or neurologist. Botox® Cannot replace a comprehensive neurological evaluation, but rather one component of it.
Our physician’s 6-step standard protocol for migraine Botox®
Consultation + headache diary review + subtype classification
30 Free consultation includes a comprehensive headache history review, MIDAS disability scoring, red-flag symptom screening, and — where indicated — a recommendation to first pursue neurology referral or imaging before proceeding.no diagnostic classification, no injection.
4 weeks of headache diary (if not already kept)
For patients without an existing headache diary, we recommend tracking for 4 weeks first — recording headache days, severity, triggers, and acute medication use — to inform Objective assessment of treatment outcomes. This step significantly improves treatment satisfaction.
Informed consent + customized injection protocol
Our physician personally explains the PREEMPT 31-point protocol, potential adverse reactions, alternative options, and the maintenance schedule. The plan is adjusted according to each patient’s subtype — adding masseter points for bruxism, and cervical/shoulder points for desk-worker patterns.
Injection treatment (approximately 20–30 minutes)
All 31 injection points (or the modified protocol) are administered by our physician herself — not a Registered Nurse, not a technician. A cold compress is applied after injection; you can leave immediately and carry on with your day.
Evaluation period (4 weeks + 12 weeks post-injection)
4 Follow-up by phone or WeChat to monitor onset of effect; in-person follow-up at 12 weeks for quantitative comparison against headache diary.A proper assessment of treatment efficacy requires a full 2 cycles (24 weeks).
Maintenance phase (once every 12 weeks, ongoing)
For patients who respond well, maintenance treatment every 12 weeks is recommended. Some patients achieve a significant reduction in headache frequency after 6–12 cycles, at which point extending the interval or pausing to observe may be considered.
Treatment timeline — how long before you see results?
| diagnostic classification | onset of effect | peak effect | responder assessment | maintenance cycle |
|---|---|---|---|---|
| chronic migraine | 2-4 weeks | 8-12 weeks | 2 treatment cycles (24 weeks) | every 12 weeks |
| Mixed-type headache (tension + migraine) | 1-3 weeks | 6-10 weeks | 2 treatment cycles | every 12–16 weeks |
| bruxism-triggered type | 2-3 weeks | 4-6 weeks | 1-2 treatment cycles | every 4–6 months |
| menstrual-related subtype | 1 complete menstrual cycles after | 2-3 treatment cycles | 2-3 treatment cycles | every 12 weeks |
Clinical note:Do not conclude that Botox® is “ineffective” after just one treatment cycle — the PREEMPT clinical trials demonstrated that approximately 25% of eventual responders do not show meaningful improvement until benefit not seen until the second treatment cycle. Among our patients in Nanjing who completed a full two-cycle evaluation, approximately 65–70% achieved a meaningful response — defined as a ≥50% reduction in headache days.
Are you a candidate for migraine Botox® treatment? 2-minute self-assessment
✅ appropriate to begin evaluation
- ✓≥ 15 headache days per month, sustained for ≥ 3 months
- ✓at least 8 days meeting migraine criteria (pulsating quality / photophobia and phonophobia / nausea)
- ✓Oral preventive medications have been ineffective or poorly tolerated
- ✓Previously diagnosed with migraine by a neurologist or family physician
- ✓Willing to complete a full 2-cycle (24-week) evaluation
- ✓open to the concept of long-term maintenance treatment
❌ treatment should be deferred or the underlying issue addressed first
- ✗Currently pregnant or breastfeeding
- ✗Myasthenia gravis / Eaton-Lambert syndrome
- ✗Active infection at the injection site
- ✗Allergy to botulinum toxin or human serum albumin
- ✗Sudden severe headache / focal neurological signs (requires medical evaluation before treatment)
- ✗Expecting a single injection to be curative (unrealistic expectation)
Luowei Physician-Led Migraine Botox® Protocol vs. Typical MedSpa
- ✗Proceeding to inject without diagnostic classification, based solely on a patient self-reporting “We have headaches”
- ✗Reduced to “a few forehead injections” (cosmetic dosing)
- ✗Performed by a nurse or technician without physician presence
- ✗Not using the PREEMPT 31-point protocol
- ✗Failure to screen for red-flag symptoms, creating risk of missed diagnosis
- ✗Without a headache diary, objective outcome assessment is not possible
- ✗Told after one unsuccessful cycle that they are “not a candidate”
- ✓Mandatory: headache diary + MIDAS score + red-flag screening
- ✓Strict PREEMPT 31-point protocol (with Asian facial anatomy adjustments)
- ✓Our physician — personal consultation and injection
- ✓individualized bruxism / neck-and-shoulder combined protocol
- ✓Neurology referral or imaging recommended first when clinically indicated
- ✓Objective quantitative assessment (headache days / VAS score / acute medication use)
- ✓Complete 2-cycle evaluation framework + maintenance plan
Why is Luowei Medical Aesthetics Clinic’s migraine content trustworthy?
Experience clinical experience
Expertise clinical expertise
Authoritativeness authority
Trustworthiness credible
All patient cases on this page are shared with signed Media Release Form authorization · Clinical data available upon request
About the cost of migraine Botox® treatment
Pricing for migraine Botox® varies widely across clinics — but the true cost isn’t about the drug itself. It’s about who assesses you, who makes the clinical judgment, and how much medical expertise the treatment actually requires. Migraine Botox® is a neurological preventive therapy with dual approval from NMPA and the FDA — not a simple cosmetic injection. The PREEMPT 31-point protocol involves multiple anatomically sensitive injection zones, requiring diagnostic classification, red-flag symptom screening, and differential diagnosis from other headache types — all of which demand physician-level clinical judgment. We maintain that all injectable treatmentsAll procedures are performed by our physician personally — this is not a matter of protocol, but of how clinical resources are structured. The price difference in laser treatments fundamentally reflects the gap in clinical experience between physician-performed and technician-performed care. For migraine Botox®, where the level of risk and clinical judgment is considerably higher, physician involvement is not optional — it is an integral part of the treatment itself. The right treatment plan for you is determined by your headache subtype and MIDAS score, not by price — all of this will be discussed in detail during your consultation.
- Payment is made at the clinic, after the consultation and before treatment begins
- Nothing is paid in advance, and no deposit is required to hold an appointment
- Cosmetic treatment is a self-pay item and is not covered by public medical insurance in China
- All new patients receive a 30-minute complimentary Consultation & Assessment
Risks & Contraindications — what we need to be transparent about
What are the main risks?
1. injection site soreness / bruising(common, resolves within 24–72 hours); 2. temporary reduction in neck muscle strength(rare, resolves naturally within 1–3 weeks); 3. Brow ptosis / heavy eyelids (technique-related; avoidable with strict adherence to the PREEMPT protocol); 4. Transient worsening of headache (rare within the first 1–2 weeks post-injection, self-limiting); 5. Allergic reaction (extremely rare); 6. Botox® non-response (approximately 30–35% of patients show insufficient response within 2 treatment cycles).
Who are absolute contraindications?
Pregnancy or breastfeeding; myasthenia gravis or Eaton-Lambert syndrome; active infection at the injection site; allergy to botulinum toxin or human serum albumin; sudden severe headache or unassessed focal neurological signs; unrealistic expectations (believing a single injection will provide a permanent cure) — in any of these situations, our physician will recommend deferring treatment or addressing the underlying issue first.
What should we know before and after treatment?
Before treatment: discontinue blood thinners (with your prescribing physician’s approval), avoid alcohol for 24 hours, and do not arrive on an empty stomach. After treatment: avoid bending forward or lying flat for 4 hours; avoid strenuous exercise, sauna, and hot yoga for 24 hours; avoid heavy makeup on the evening of treatment. There is minimal downtime — you can return to work immediately.
What does the informed consent form include?
Before your first treatment, every patient signs an informed consent form covering: the mechanism of Botox® and the PREEMPT protocol; possible adverse reactions and their likelihood; alternative options (other neuromodulators or oral preventive medications); criteria for discontinuing treatment; follow-up arrangements; and a Media Release (optional). All content is explained by our physician personally — not delegated to administrative staff.
Where the medical claims on this page come from
Everything above about migraine rests on published evidence rather than on our own word. The sources below are the ones behind those statements: peer-reviewed papers indexed in PubMed, and guidance written for patients by dermatology academies and national health services. Read them before you decide — and bring any of them to your consultation.
- Peer-reviewedBotulinum toxin type A for facial wrinkles
- Peer-reviewedBotulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique
- Patient guidanceWrinkles
- Patient guidanceDermal fillers: Overview
- Patient guidanceBotulinum toxin: Overview
What these references can and cannot tell you. They describe what is known about the treatment itself — how well it tends to work, how long results last, and what can go wrong. They are not an assessment of this clinic, and no published study can tell you whether it suits your skin type, anatomy, or medical history. That judgement comes from the physician who examines you in person, and it may well be “not this one”.