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Migraine

Botox for migraine prevention

Botulinum toxin, migraine prevention
Other names: Botox, botulinum toxin, botulinum toxin type A, onabotulinumtoxinA

FAA guidance

Special issuance required.

Wait

1 month

ground trial when starting

Different waits apply in other cases.

FAA label

SI CONDITIONAL

Source: FAA, Migraine Medication. FAA date 26 August 2026. Checked by Crosscheck 14 October 2026

The FAA lists Botox for migraine prevention as SI-conditional, requiring a special issuance, with a one-month ground trial and 72 hours of no-fly after each dose; it notes Botox is reserved for severe refractory headaches.

Track your medications
More detail: Botox for migraine preventionThe rest of Crosscheck's reading, in plain wordsOpen

Wait

  • 72 hours after each dose

It says Botox may cause delayed adverse effects such as muscle weakness, excessive fatigue or eye symptoms.

  • 72 hours after each dose: ground observation

FAA rule for migraine medication: The FAA says migraine relief or rescue medication is acceptable when used occasionally and unacceptable for daily use, and that its post-dose observation time (no-fly warning) is based on the drug's half-life. It says that if several relief medications are needed on a recurring basis to stop symptoms, this is considered a complicated migraine, and the examiner should defer. For relief or rescue medication the worksheet lists, the FAA's CACI – Migraine and Chronic Headache Worksheet says the examiner can issue if the pilot meets all of its acceptable certification criteria, which include no more than one episode per month, no more than 2 outpatient clinic or urgent care visits for symptom exacerbation in the last 12 months (even if symptoms fully resolved), and no history of in-patient hospitalizations for headaches; it says narcotics, Fiorinal, Fioricet and Midrin are not acceptable for relief or rescue. FAA, Migraine Medication

Show the FAA's words: Botox for migraine preventionThe official FAA wording: one passage, each with its document and dateOpen
FAA, Migraine Medication · FAA date 26 August 2026
Botox is not a first-line treatment for migraines. It is reserved for individuals with severe refractory headaches.
May cause delayed adverse effects such as muscle weakness, excessive fatigue, or eye symptoms.
Requires Special issuance.
SI CONDITIONAL – Migraine Prevention (Prophylaxis)
No-Fly Time After each dose
botulinum toxin (Botox), 1 month, 72 hours
Sources and dates: Botox for migraine preventionOne FAA document, with the FAA's date and when Crosscheck checked itOpen

See also

Medication guidance alone does not determine whether a pilot is medically qualified to fly. The underlying condition, dosage, side effects, medication combinations, and certification history may affect FAA eligibility.

For informational purposes only. Not legal or medical advice.