Markham, Ontario · Physician-performed

Botox for Chronic Migraine in Markham

Neuromodulator therapy is an effective, Health Canada-approved treatment for chronic migraine, helping reduce the frequency and severity of headache days. Regular treatments can improve quality of life and decrease reliance on pain medications for eligible patients.

Price

from $800

Appointment

45 minutes

Performed by

Dr. Mazzuca, MD

Location

Markham, ON

Book a Consultation   Book Chronic Migraine Therapy directly

Quick answer

Botox for chronic migraine in Markham at Dr. Monique Mazzuca Aesthetics is from $800, performed personally by a licensed physician (MD, CCFP) at 200 Cachet Woods Court, Suite 309, in a 45-minute appointment. It is a preventive treatment for adults with chronic migraine, meaning headaches on 15 or more days a month: small doses are injected into set points across the forehead, temples, back of the head, neck and shoulders, and repeated about every 12 weeks. Benefit usually builds over the first two to three treatment cycles. It is not designed for occasional migraine. New patients start with a $50 consultation.

What chronic migraine is

Migraine is a neurological condition, not "just a bad headache". Attacks are often one-sided and throbbing, and can come with nausea, sensitivity to light and sound, and sometimes an aura. Most people with migraine have episodic migraine, with fewer than 15 headache days a month. Chronic migraine is defined as headache on 15 or more days a month for more than three months, with migraine features on at least 8 of those days.

Chronic migraine affects work, family life and sleep, and it often drives frequent use of pain relievers. Taking acute headache medication on many days a month can itself make headaches more frequent, a pattern called medication overuse headache. A preventive treatment that reduces the number of headache days can help break that cycle.

How Botox helps chronic migraine

Botox® (onabotulinumtoxinA) is approved in Canada as a preventive treatment for chronic migraine in adults. It is the same medicine used cosmetically for frown lines, but the dose, injection pattern and goal are different. It is not a painkiller to take during an attack. It is given on a schedule to reduce how often headaches happen.

The exact mechanism is still being studied. The current understanding is that, in addition to relaxing muscles, Botox reduces the release of pain-signalling chemicals from sensory nerve endings in the head and neck. Over time this appears to make the pain pathways that drive migraine less easily triggered. The treatment follows a standard protocol developed in large clinical trials: small doses at about 31 set points across seven muscle areas of the head and neck, repeated about every 12 weeks, with some additional points sometimes added where pain is most concentrated.

Botox for migraine in Markham: what it treats

The goal of treatment is to:

• Reduce the number of headache and migraine days each month in adults with chronic migraine.
• Lessen the severity of attacks that still happen, for many patients.
• Reduce reliance on acute pain medication, which can help with medication overuse headache.
• Improve day-to-day function, including work, sleep and family life.

Botox is not recommended for episodic migraine (fewer than 15 headache days a month) or for tension-type headache, because studies have not shown a clear benefit in those groups.

Who it suits, and who should wait

The treatment is designed for adults with a diagnosis of chronic migraine, usually people who have already tried, not tolerated or not done well on at least one or two oral preventive medications. Many patients come with a referral or recommendation from their family doctor or neurologist; others are diagnosed or confirmed at their assessment here. Bringing a headache diary of the last one to three months is very helpful, because it confirms the diagnosis and gives a baseline to measure progress against.

Dr. Mazzuca will review your history and may postpone or advise against treatment if you:

• are pregnant, trying to conceive or breastfeeding;
• have an infection or skin problem at the injection sites;
• have a neuromuscular condition such as myasthenia gravis, ALS or Lambert-Eaton syndrome, or significant neck weakness or swallowing problems;
• have had an allergic reaction to a botulinum toxin product before;
• take certain medications that can interact, such as aminoglycoside antibiotics;
• have headaches that have not yet been properly assessed.

Important: a sudden, severe "worst ever" headache, a headache with weakness, numbness, confusion, vision loss or difficulty speaking, a headache after a head injury, or a new pattern of headache after age 50 needs urgent medical assessment. Go to an emergency department or call 911. These are not reasons to book a clinic appointment.

What the appointment is like

1. Assessment. Dr. Mazzuca reviews your headache history, diary, current and past medications, and any red flags, and confirms that the treatment is appropriate. She explains the plan and cost before starting.
2. Positioning. You sit comfortably. The injection points are on the forehead, temples, the back of the head, the back of the neck and the tops of the shoulders.
3. Injection. About 31 very small injections are given with a fine needle, plus occasional extra points where your pain is concentrated. Each feels like a quick pinch or sting. Numbing is not usually needed. The injections themselves take around 15 minutes.
4. After. You receive written aftercare and a reminder to keep your headache diary. Your next treatment is planned for about 12 weeks later.

The appointment is booked for 45 minutes. Most patients drive themselves and return to work the same day. Small bumps at the injection points settle within about half an hour.

When it works and how long it lasts

Some patients notice fewer headache days within the first two to four weeks, but for many the benefit builds gradually. Because of this, treatment is usually continued for at least two to three cycles (about six to nine months) before deciding whether it is working. Each treatment typically lasts about 12 weeks, and some patients notice headaches creeping back in the last week or two before their next session.

Response varies. Many patients have a meaningful reduction in headache days and in the severity of attacks; some have a modest response; and some do not benefit enough to continue. Your diary is the best way to judge this. If the treatment is working well, it is continued on a regular schedule and reviewed periodically. If it is not, Dr. Mazzuca will discuss other options with you and, where appropriate, with your family doctor or neurologist.

Side effects and risks

Botox has a long safety record for chronic migraine when given by a trained physician. Common, temporary effects include:

• neck pain, stiffness or a feeling of neck weakness, usually for a few days to a couple of weeks;
• soreness, small bruises or redness at the injection points;
• a headache in the first day or two after treatment;
• a heavy feeling in the brow or forehead, or a temporary droop of the brow or eyelid.

Most effects settle on their own as the body adjusts and often lessen with later treatments. Because of the injections into the forehead, forehead lines usually soften as well. Spread of toxin effect beyond the injection site, which could cause muscle weakness, swallowing or breathing difficulty, is a labelled warning for all botulinum toxin products; it is rare at these doses. Serious allergic reactions are very rare. Seek urgent care if you have difficulty swallowing, speaking or breathing after treatment.

Aftercare

• Stay upright for about four hours after treatment.
• Do not rub or massage the injection sites for 24 hours, and avoid tight headbands or hats over the treated areas that day.
• Skip strenuous exercise, saunas and hot yoga for 24 hours.
• Continue your usual migraine medications unless your physician tells you otherwise. Botox is added to your plan, not a replacement for the rest of it.
• Keep your headache diary going, recording headache days, severity and medication use.
• Book your next treatment for about 12 weeks out, so there is no gap in coverage.

How it fits with other migraine treatments

Migraine care usually combines several tools. Botox is one preventive option among others, and the right mix depends on your health, other conditions, preferences and response.

Approach	How it is used	Notes
Acute (rescue) medication	Taken at the start of an attack	Needed by most patients; overuse can worsen headaches
Oral preventive medications	Taken daily to reduce attack frequency	Several families of medicine; side effects vary; usually tried first
Newer targeted preventives (CGRP-based)	Monthly or quarterly injections, or tablets	Prescribed by your physician or neurologist; coverage varies
Botox for chronic migraine	Injections about every 12 weeks	For chronic migraine only; benefit builds over cycles; can be combined with other preventives
Lifestyle and trigger management	Sleep, meals, hydration, exercise, stress, limiting caffeine and alcohol	Supports every other treatment

Botox for migraine is a medical use of the same medicine Dr. Mazzuca uses cosmetically for frown lines and forehead lines and medically for excessive sweating. If you are already a cosmetic patient, tell her about your headaches. Cosmetic doses are much smaller and are not a treatment for migraine, and the two plans need to be coordinated rather than given separately.

Why patients choose a physician

At this clinic the person assessing you and the person treating you are the same person, and that person is a licensed physician. Dr. Mazzuca is an MD with CCFP certification in family medicine and additional training in cosmetic medicine, facial anatomy, women's health, and longevity medicine. Treatment is not delegated.

Her stated approach is to emphasise "subtle, elegant results that refresh rather than transform, using the least invasive treatments necessary to achieve safe, natural, and lasting outcomes."

For migraine this goes beyond technique. As a family physician, Dr. Mazzuca is trained to take a full headache history, recognise warning signs that need a different work-up, look at medication overuse, and consider other conditions and medications that affect your plan. She can coordinate with your family doctor or neurologist so that Botox fits into your wider migraine care rather than sitting apart from it.

Booking, pricing and what happens next

Step	What it involves	Cost
1. Consultation	Facial and skin assessment, discussion of goals, customized plan	$50 (30 min)
2. Virtual option	Video consult if you are outside the Markham area	$20 (15 min)
3. Chronic Migraine Therapy	Treatment performed by Dr. Mazzuca	from $800 (45 minutes)

All appointments are booked online through the clinic's booking system, where current availability and pricing are shown before you confirm.

Treatment is from $800 at the clinic, and the exact cost is confirmed at your assessment. Because each treatment lasts about 12 weeks, most patients have about four treatments a year. As an illustration only, at the starting price of $800 that is from about $3,200 a year before any insurance coverage.

Chronic migraine is a medical condition, and some private insurance plans cover part of the cost of Botox for chronic migraine, often with a prior authorization form showing the diagnosis and previous treatments tried. Coverage varies widely, so check with your plan before booking. Dr. Mazzuca can provide the medical documentation your insurer may ask for.

Serving Markham and the Greater Toronto Area

The clinic is located at 200 Cachet Woods Court, Suite 309 in the Cachet Woods area of Markham, near Woodbine Avenue and Major Mackenzie Drive, with parking on site. Patients travel from Unionville, Richmond Hill, Vaughan, Aurora, Stouffville, Thornhill, North York, Scarborough and the wider GTA. If you are outside the area, a virtual consultation is available before you commit to an in-person visit.

Frequently asked questions

Sources and further reading

• BOTOX (onabotulinumtoxinA) Canadian Product Monograph: chronic migraine indication, dosing and adverse reactions (AbbVie Canada).
• PREEMPT clinical trials of onabotulinumtoxinA for the prevention of chronic migraine.
• Canadian Headache Society guideline for migraine prophylaxis.
• College of Physicians and Surgeons of Ontario, public register, for verification of Dr. Mazzuca's registration.

Every treatment on this page is booked through Dr. Mazzuca's secure online system. New patients begin with a consultation; returning patients can book the treatment directly.

Written and medically reviewed by Dr. Monique Mazzuca, MD, CCFP. Last reviewed 2026-08-07.

This page is general information, not medical advice, and it is not a substitute for an in-person assessment. Results vary between patients, and every treatment carries risks that are reviewed with you before you consent. Suitability is determined by Dr. Mazzuca at your consultation.

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