Key Points

• Botox is used as a therapeutic treatment for many conditions, including for prevention of migraine headaches, and Botox Cosmetic is used for aesthetic purposes to lessen wrinkles like crow's feet or forehead lines.
• Botox and Botox Cosmetic are prescription medicines that both contain the active ingredient onabotulinumtoxinA, but they come as separate products.
• Originally when Botox was first approved for wrinkles, doctors found it all also helped patients with migraine headaches. It was eventually approved by the FDA for migraine prevention in 2010.
• Both treatments are given as injections into the muscles of the face, neck or head, depending upon the use. You will need more injections per session for migraine prevention than for wrinkle treatment.
• Botox (for the treatment of chronic migraine) and Botox Cosmetic are for use in adults only.

Learn More: Compare Botox vs Botox Cosmetic

In addition to prevention of chronic migraine headache in adults, Botox is also approved to treat:

• overactive bladder
• leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease
• muscle spasticity
• cervical dystonia (abnormal head position and neck pain)
• certain types of eye muscle problems or eyelid spasms
• severe underarm sweating

Botox Cosmetic is approved for adults to temporarily help improve the look of moderate to severe facial wrinkles:

• forehead lines
• crow’s feet lines
• frown lines between the eyebrows.

Botox Cosmetic is supplied in different unit vial sizes from Botox.

• Botox used for migraine comes in 100 and 200 unit single-use vials, while Botox Cosmetic for wrinkles comes in 50 and 100 unit single-use vials.
• Reconstitution and dilution instructions in the package insert vary between these two products.
• Potency Units of Botox Cosmetic or Botox are not interchangeable with other preparations of botulinum toxin products.

Botox dose for migraine: The recommended total dose for chronic migraine is 155 Units, as 0.1 mL (5 Units) injections per each site divided across 7 head/neck muscle areas, for a total of 31 individual injections. These areas include the forehead, bridge of the nose, the temples, the neck, the back of the head, and just above the shoulder blades in your upper back.

Botox Cosmetic dose for wrinkles: The recommended dose for wrinkles varies based on wrinkle type and typically ranges from 20 to 24 units per wrinkle area. The units per injection site will vary by patient and can be determined by a qualified injector for optimal results.

Can I get Botox and Botox Cosmetic at the same time?

Yes, you can receive Botox and Botox Cosmetic for different uses at the same time as long as the total dose received of onabotulinumtoxinA does not exceed 400 Units administered in a 3 month period for adults.

You may also receive Botox Cosmetic treatment for treatment of different wrinkle areas at the same time. It is not known if Botox Cosmetic is safe and effective for use more than once every 3 months.

The dilution and the resulting units per 0.1 mL (as noted in the package insert) are different between Botox and Botox Cosmetic. Health care providers should see the specific instructions for reconstitution and administration of each product.

Warnings: Botox and Botox Cosmetic may cause serious side effects that can happen hours, days, or weeks after an injection and can be life threatening. These include:

• Problems breathing or swallowing
• Spread of toxin effects (leading to symptoms of a serious condition called botulism)

Call your doctor or get medical help right away if you have any of these problems after treatment.

According to the manufacturer, there has NOT been a confirmed serious case of spread of toxin effect away from the injection site when Botox has been used at the recommended dose to treat chronic migraine or when Botox Cosmetic has been used at the recommended dose to treat approved wrinkle areas.

What are Botox or Botox Cosmetic side effects?

• dry mouth
• discomfort or pain at the injection site
• tiredness
• headache
• neck pain
• eye problem
• drooping eyebrow
• urinary tract infection and painful urination
• inability to empty your bladder
• allergic reaction
• upper respiratory tract infection

Review these warnings and side effects in this Medication Guide for Botox and Botox Cosmetic. Tell your doctor if you have a side effect that does not go away or that concerns you.

Bottom Line

• Botox Cosmetic is used for aesthetic purposes for wrinkles and Botox is used as a therapeutic treatment for many medical conditions, including migraine headache prevention.
• Botox Cosmetic and Botox come as separate products but are both prescription medicines that contain the active ingredient onabotulinumtoxinA.
• The number of injections needed for migraine prevention are more than the number needed for wrinkle treatment.
• Both products are given as injections into the muscles of the face, neck or head, depending upon the use. You can receive both products as long as the total amount does not exceed 400 Units administered in a 3 month period for adults.

This is not all the information you need to know about Botox or Botox Cosmetic for safe and effective use for migraine. Review the full Botox or Botox Cosmetic information here, and discuss this information and questions with your doctor or other healthcare provider.