Injection Treatment for Chronic Migraine in Sydney
PBS-listed treatment by a neurologist accredited in the standard injection protocol. Trained at Prince of Wales Hospital, Sydney.
Book a ConsultationInjection Treatment for Migraine — The Basics
This injection treatment is a preventative for chronic migraine — not an acute treatment. The medicine works by blocking the release of pain-signalling chemicals at peripheral nerve endings in the scalp and neck, reducing the sensitisation that drives migraine. It has been on the Pharmaceutical Benefits Scheme (PBS) in Australia for chronic migraine since 2014.
Dr Ron Granot is an accredited injector for chronic migraine using the standardised protocol. He trained at Prince of Wales Hospital, Sydney, and has given many hundreds of treatment cycles for chronic migraine.
PBS Eligibility for the Injection Treatment
The treatment is PBS-subsidised for chronic migraine only when specific criteria are met. The criteria define a tightly defined patient group with treatment-resistant chronic migraine.
Patient must meet ALL of the following
- Chronic migraine — 15 or more headache days per month, with at least 8 being migraine, for 3 months or more
- Adequate trials of at least 3 oral preventatives from different classes — each at adequate dose and duration, discontinued for inefficacy or intolerance
- Treatment prescribed by a neurologist or pain medicine specialist (Dr Granot meets this)
- Not concurrently receiving one of the newer preventive medicines subsidised by the PBS for migraine
Reassessment — Authority approval is granted for 2 cycles initially; continuation requires demonstrating ≥50% reduction in headache days.
What to Expect at Your Injection Appointment
Pre-treatment consultation
Review of your headache diary, prior preventative trials, and confirmation of PBS eligibility. A baseline assessment is essential — we cannot demonstrate response without documented baseline headache days. If you don't have a recent diary, we'll start one before treatment.
PBS authority application
Dr Granot submits the PBS authority application on your behalf. Approval typically comes through within days. You collect the medicine from your pharmacy (or it is provided in-rooms depending on supply).
The injection procedure
31 small injections into the muscles at standardised sites: forehead and brow (7), temples (8), back of the head (6), neck (4) and upper shoulders (6). The actual injecting takes about 8 minutes. The procedure feels like a series of small pinpricks; most patients finish saying it was nowhere near as bad as what they had expected.
"Follow the pain" technique: beyond the standard sites, additional injections are added at sites of localised pain or trigger points. In Dr Granot's experience this can improve response rate.
After the injection
You can drive home and resume normal activities the same day. Avoid lying flat for 4 hours and avoid massaging the injection sites for 24 hours. Mild neck stiffness for a few days is the most common after-effect.
Follow-up & response assessment
The next cycle is at 12 weeks. Response is formally assessed after cycle 2 using your continuing headache diary. PBS continuation requires ≥50% reduction in headache days from baseline. Most responders notice benefit by cycle 2; a minority respond after cycle 1 or take 3 cycles.
Where Do the Injections Go? The 31 Standard Sites
The treatment follows a fixed map — the injection pattern used in the clinical trials that proved it works in chronic migraine. The standard treatment is 31 small injections across seven muscle areas of the head, neck and shoulders. The pattern covers the nerves that carry migraine pain, not just the muscles that happen to feel sore.
| Area | Muscles | Injections |
|---|---|---|
| Forehead and brow | Frontalis, corrugator, procerus | 7 sites |
| Temples | Temporalis | 8 sites |
| Back of the head | Occipitalis | 6 sites |
| Neck | Cervical paraspinal muscles | 4 sites |
| Shoulders | Upper trapezius | 6 sites |
| Total | 7 muscle areas, both sides | 31 sites |
"Follow the pain": the protocol also allows up to 8 extra injections — 2 in the temples, 2 at the back of the head and 4 in the shoulders — placed where your pain is most concentrated. Dr Granot uses this tailoring routinely rather than treating every patient with an identical map; in his experience it can improve the response. He explains the approach in detail in his article on migraine injections.
What Do the Migraine Injections Feel Like?
Each injection is a brief sting — most patients describe it as a small pinprick — and there are 31 of them, so the honest answer is a few minutes of minor discomfort. The injecting itself takes about 8 minutes; allow 15–20 minutes in the room. No anaesthetic or sedation is needed, and ice or simple distraction helps if you are needle-averse. There is no downtime: you can drive home and go back to work the same day.
For the rest of the day, avoid lying flat for 4 hours and don't rub or massage the injection sites for 24 hours. The most common after-effect is a little scalp or neck soreness for a day or two. Most patients finish their first session saying it was nowhere near as bad as they had expected — and the sessions get quicker as the pattern is refined for you.
Side Effects — How Common Are They?
In general there are few. Because the medicine stays where it is injected, it avoids the day-to-day side effects that come with daily preventive tablets. What it can cause is local, and temporary.
| Side effect | How common | What it is like |
|---|---|---|
| Soreness at the injection sites | Common | Settles within a day or two |
| Neck pain or stiffness | About 4% | A few days — the most common after-effect |
| Brief worsening of migraine | About 4% in the trials | A few days, then settles |
| Brow heaviness | Uncommon | Temporary |
| Itch or rash at an injection site | Under 1% | Mild and short-lived |
| Drooping eyelid (ptosis) | Rare | Temporary — settles over days to a few weeks |
Where most patients sit
For most people the side effects amount to a little soreness for a day or two, and serious problems are genuinely uncommon when the injections are given by an experienced injector who knows the anatomy. In many hundreds of cycles Dr Granot has seen a drooping eyelid once, and it resolved within days. The treatment is not suitable for people with a neuromuscular condition such as myasthenia gravis. Tell us if that applies to you, or if you are pregnant, planning a pregnancy or breastfeeding.
What Response Looks Like — Realistic Expectations
In the original clinical trials, 40–50% of patients achieved >50% reduction in headache days per month with the treatment. In post-trial data presented at the Congress of European Neurology (2017), 65% of first-time patients were satisfied or very satisfied with their treatment. Comparable response rates to oral preventatives — but with the convenience of treatment every 12 weeks and few systemic side effects.
Practical framing: a meaningful proportion of patients see substantial benefit; a smaller proportion see partial benefit; and some are non-responders despite optimal technique. PBS continuation requires demonstrated ≥50% reduction in headache days after cycle 2. Honest framing of these numbers up-front is part of how we discuss treatment.
What the treatment is good at
- Reducing total headache days per month
- Reducing severity of headaches that do occur
- Reducing dependence on acute medications (helps medication-overuse cycles)
- Convenient treatment every 12 weeks — no daily tablets to remember
- Few systemic side effects compared with oral preventatives
What the treatment is not
- Not an acute treatment — doesn't stop a migraine in progress
- Not a cure — discontinuing treatment generally returns headaches to baseline
- Not universally effective — about 50% see meaningful benefit by cycle 2
- Not first-line — used after oral preventatives have failed
How Much Does Injection Treatment for Migraine Cost in Sydney?
If you meet the PBS criteria, the medicine itself is subsidised — you pay the standard PBS co-payment for the medication, the same as any PBS script. The injection appointment carries a consultation and procedure fee, which attracts a Medicare rebate; your rebate is processed for you on the day. A detailed quote is provided when you book.
Outside the PBS criteria — for example, fewer than 15 headache days a month — the medication must be paid for privately, and it is significantly more expensive. That is one reason the headache diary matters: it is what establishes eligibility. Dr Granot submits the PBS authority application on your behalf.
Injections or Newer Preventive Medicines — When to Choose Which
Both this injection treatment and the newer preventive medicines are PBS-listed preventative options for migraine. They work differently and PBS rules currently prevent claiming both simultaneously. The choice depends on individual factors.
| Factor | Injection treatment | Newer preventive medicines |
|---|---|---|
| PBS indication | Chronic migraine — ≥15 headache days/month with ≥8 migraine days | Chronic migraine — ≥8 headache days/month (three are PBS-listed; a fourth is private only) |
| How often | Every 12 weeks, in-rooms procedure | Monthly or every 3 months — usually a self-injection at home; one is a drip in a clinic every 3 months |
| Time to response | Often after cycle 2 (24 weeks) | Often within 4–8 weeks |
| Onset side effects | Neck stiffness, mild brow heaviness | Injection-site reactions, mild constipation, rare allergic reactions |
| Concurrent use | Not concurrently PBS-subsidised. Sequential trials permitted under authority. | |
Frequently Asked Questions
Considering Injection Treatment for Your Migraines?
Book a consultation with Dr Ron Granot — accredited injector for chronic migraine and neurologist with a special interest in headache, Bondi Junction.
Book a ConsultationBook Your Appointment Today
Stop waiting years for answers. Fill out the form below and we'll contact you to schedule your appointment.
Thank you for getting in touch!
One of our colleagues will get back to you shortly.
Have a great day!