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Where to Inject Botox for Migraine: Injection Sites for Practitioners

The standard PREEMPT protocol uses 31 injection sites across 7 head and neck muscle areas for the preventive treatment of chronic migraine.

Explore the injection areas, dosing distribution and anatomical regions used in the established treatment paradigm.

View the 31 Injection Sites Shop Botulinum Toxins
Practitioner marking PREEMPT migraine injection sites on a patient's forehead and temple
  • 31 Standard injection sites
  • 7 Head & neck muscle areas
  • 155 Total BOTOX® Units

PREEMPT treatment paradigm

PREEMPT Injection Sites for Chronic Migraine

The PREEMPT protocol uses a standardized fixed-site, fixed-dose pattern rather than targeting only the patient's perceived pain location.

For BOTOX® (onabotulinumtoxinA), the labeled fixed-site protocol distributes treatment across the corrugator, procerus, frontalis, temporalis, occipitalis, cervical paraspinal, and trapezius muscle groups.

The illustration provides a high-level anatomical overview of the anterior, lateral, and posterior treatment regions.

Front, side and back views showing the seven PREEMPT muscle areas and injection points

31 Botox Injection Sites at a Glance

Muscle area Sites Total dose
Corrugator210 U
Procerus15 U
Frontalis420 U
Temporalis840 U
Occipitalis630 U
Cervical paraspinals420 U
Trapezius630 U
Total31155 U

Anatomical areas

The 7 Botox Injection Areas for Chronic Migraine

Each muscle region contributes a defined number of injection sites within the standard fixed-site, fixed-dose protocol.

  1. 01 2 sites · 10 units

    Corrugator

    Front view highlighting the two corrugator injection sites above the inner eyebrows

    The corrugator treatment pattern consists of bilateral sites, with 5 Units administered per site for a total dose of 10 Units.

  2. 02 1 site · 5 units

    Procerus

    Front view highlighting the single midline procerus injection site

    The procerus receives one midline injection of 5 Units within the fixed-site PREEMPT protocol.

  3. 03 4 sites · 20 units

    Frontalis

    Front view highlighting four bilateral frontalis injection sites across the forehead

    The frontalis receives four injection sites distributed bilaterally, with 5 Units per site for a total dose of 20 Units.

  4. 04 8 sites · 40 units

    Temporalis

    Side view highlighting the temporalis injection sites on the side of the head

    The temporalis receives four fixed injection sites per side, for eight sites and a total dose of 40 Units.

  5. 05 6 sites · 30 units

    Occipitalis

    Back view highlighting six bilateral occipitalis injection sites at the back of the scalp

    The occipitalis treatment pattern consists of three sites per side, providing six bilateral sites and a total dose of 30 Units.

  6. 06 4 sites · 20 units

    Cervical Paraspinals

    Back view highlighting four cervical paraspinal injection sites either side of the upper neck

    The cervical paraspinal muscle group receives two sites per side for a total of four injection sites and 20 Units.

  7. 07 6 sites · 30 units

    Trapezius

    Back view highlighting six bilateral trapezius injection sites across the upper shoulders

    The trapezius receives three injection sites on each side, for six sites and a total dose of 30 Units.

Visual reference

PREEMPT Injection Pattern: Anterior, Lateral & Posterior Views

Anterior, lateral and posterior views of the 31-site PREEMPT injection pattern with each muscle area labelled
Illustrative anatomical reference. Use alongside current prescribing information, formal anatomical training, and clinical judgment.

Fixed-Site, Fixed-Dose Distribution

The 31-site pattern comes from the PREEMPT clinical program, which established a standardized approach to using onabotulinumtoxinA for chronic migraine prevention.

7 muscle regions
31 fixed sites
155 U standard dose
12 wk typical retreatment interval

Patient selection

Patient Selection for Chronic Migraine Treatment

BOTOX is indicated for the prevention of headaches in adults with chronic migraine. Patient selection should follow the approved indication, current labeling, and individual clinical assessment.

The treatment paradigm is therapeutic and distinct from cosmetic botulinum toxin protocols in both treatment objective and injection distribution.

Therapeutic vs aesthetic

Botox for Migraine vs Cosmetic Botox

Botox for Chronic Migraine Cosmetic Botox
Main goal Prevent chronic migraine headaches Improve selected dynamic facial lines
Treatment areas Head, neck and upper shoulders Indication-specific facial/neck areas
Standard migraine pattern 31 sites across 7 muscle areas Different dosing patterns
Standard migraine dose 155 Units Depends on approved cosmetic indication
Treatment planning Therapeutic Aesthetic

Botulinum Toxin Products for Professional Practice

Explore Activa Derma's professional botulinum category and consult current product-specific information before use.

Explore Botulinums

Safety & prescribing information

Botox for Chronic Migraine Safety

BOTOX is a prescription medicine and carries important safety information, including a boxed warning.

Practitioners should review the current full prescribing information before treatment, including contraindications, warnings, precautions, adverse reactions, dosing, administration, and product-specific handling requirements.

Botulinum toxin products are not interchangeable on a unit-for-unit basis. Product selection and dosing should follow the approved labeling for the specific formulation and indication.

BOTOX is a prescription medicine and carries important safety information.

Common adverse reactions reported in chronic migraine studies include neck pain, headache, eyelid ptosis, migraine, muscular weakness, musculoskeletal stiffness and injection-site pain.

Botulinum toxin products also carry a boxed warning regarding the possibility of toxin effects spreading beyond the injection site.

For professional use only. Always consult the current full prescribing information for the specific product and indication before treatment.

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