Two large trials of Botox provide unequivocal proof of its efficacy in the treatment of chronic migraine headaches. The results of these two double-blind, placebo-controlled studies (I participated in one of the two trials) of onabotulinumtoxinA (Botox) in chronic migraines were presented at the International Headache Congress in Philadelphia last week. Botox was proven to reduce the number of days with headaches, improve multiple headache symptoms, and improve the quality of life. The treatment was extremely well tolerated with very few side effects overall and no serious side effects. Having used Botox for the treatment of various headache types for over 15 years in several thousand patients it is very gratifying to finally have well-designed trials which confirm my and my colleagues’ experience. The manufacturer is submitting the results of these trials to the FDA and we expect to have approval of Botox for the treatment of chronic migraines by the end of 2010. FDA approval will force insurance companies to pay for this highly effective treatment and will make it affordable for people who desperately need it.