Botox (Migraine) and Ketamine Therapy | Tovani Health
Botox (PREEMPT protocol) (OnabotulinumtoxinA (for chronic migraine)) — Neurotoxin (chronic migraine prevention via PREEMPT protocol)
Verdict at Tovani Health
Fully compatible with KAP.
Botox for chronic migraine and ketamine have no clinically significant interaction. The PREEMPT protocol uses 155 units injected across 31 sites every 12 weeks. The treatment is local — once injected, botulinum toxin is internalized by nerve terminals and has no systemic activity to interact with ketamine.
If you take Botox (PREEMPT protocol) regularly and are considering at-home ketamine therapy, the combination is generally safe at therapeutic doses. This page covers the brief pharmacologic context and what we do at intake.
How Botox (PREEMPT protocol) interacts with ketamine
OnabotulinumtoxinA cleaves SNAP-25, blocking acetylcholine and other neurotransmitter release at nerve terminals. Local action only. The migraine-prevention mechanism is thought to involve blockade of peripheral pain signaling pathways.
What we do at intake
Continue your 12-week injection schedule. KAP planning is independent of Botox timing.
Bottom line
Botox for chronic migraine and ketamine have no clinically significant interaction. The PREEMPT protocol uses 155 units injected across 31 sites every 12 weeks. The treatment is local — once injected, botulinum toxin is internalized by nerve terminals and has no systemic activity to interact with ketamine.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Botox (PREEMPT protocol) (OnabotulinumtoxinA (for chronic migraine)) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 19, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.