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How Is Botox For Migraines Administered

Should I Pay Injection Fees To The Physician Or The Clinic Where I Receive The Injections

Botox for Migraines

This is very variable. Access to care in Canada is supposed to equitable between provinces but it is not the case for migraine care and this is one example.

Alberta and Quebec have fee codes but other provinces dont. Physicians then have to charge fees directly to patients . Fees may vary between $100 and $200. If you receive your injections from a cosmetic physician, fees might be higher.

How Can I Find A Competent Injector

Go to: website.

This website provides a list of injectors that you can search by city or postal code.

Note that BOTOX® injectors may include neurologists, pain specialists, headache specialists, anesthesiologists, family physicians, physiatrists and other medical professionals experienced in treating migraine. Some injectors might provide injections but not a global management of migraine.

What Are Botox Treatments Like

Unlike other migraine treatments, Botox is given as a series of small injections directly into the muscle.

In a single treatment session, between 31 and 39 shots are given throughout seven different parts of the forehead, head , and neck . Each treatment cycle can last about 10 to 20 minutes. Its important that the correct sites are treated, or else the treatment may not be as effective.

Its recommended that a treatment cycle be given every 3 months in order to help control migraine attacks. How long you continue getting them will depend on how you respond to treatment. While many people improve with just one treatment cycle, some may require more. Most people seem to need fewer than three treatment cycles, but each person is different. Your doctor will work with you to see how long you should continue getting treatments and may recommend that you keep taking other medications until you see an improvement.

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How Does Botox For Migraines Work

When a person is experiencing severe pain associated with migraine, a doctor may recommend different interventions based on family history and severity. Most of these are analgesic in some way, or relieve associated secondary symptoms such as severe nausea.

Aspirin and ibuprofen are some of the most commonly prescribed over-the-counter pain meds for migraines, and paracetamol can be effective for mild attacks. Overreliance on these medications can lead to stomach and liver problems, however, which is why a more long-term treatment plan is crucial.

Other medications for immediate pain relief include CGRP antagonists, vasoconstrictors like triptans and newer drugs, and even opioid medication.

However, preventative medicine is just as important to treating a migraine problem, especially in chronic cases. This is where Botox for migraines come into play.

Botox is injected into the muscles in the neck and head in multiple different places, typically once every 12 weeks. The mechanism by which it helps relieve pain involves blocking the release of acetylcholine, a neurotransmitter that helps contract muscles and relay pain signals.

How Botox Works For Migraines

Botulinum Toxin for the Treatment of Chronic Migraines ...

Botox works by reducing muscle contractions and stopping neurotransmitters from sending pain signals to your brain. This can help reduce the pain caused by migraines and lets many patients enjoy daily life without interruption.

The effect is only temporary, so patients will need to receive ongoing treatment. The most common treatment timeline involves an injection every 12 weeks, or four times per year. It may take several weeks to experience migraine relief after an injection. Your doctor may adjust this timeline according to your individual needs.

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How To Find The Right Treatment

Botox can be a powerful tool for fighting migraine, but it can be dangerous if its not administered correctly. To lessen your chances of having any severe side effects or complications, make sure youre working with a trained healthcare professional, like a board certified physician or neurologist.

When youre selecting a doctor, make sure they have experience using Botox as a treatment.

Be prepared that some doctors and insurance companies may want you to try other treatment options first before trying Botox for migraine. Other options include lifestyle changes and other approved medications.

What To Expect During Botox Treatment

Before your first Botox treatment your neurologist should discuss the side effects and risks. This is a good time to ask questions and check if they follow the established Botox protocol for chronic migraine.

Your neurologist uses a small needle to inject 0.1ml or 5 units of Botox at each site just under your skin. You may feel a slight sting with each injection. Because Botox comes in 100 unit vials some neurologists may do a few more injections around areas where you experience your migraine pain.

The treatment takes about 1520 minutes and there arent any restrictions on driving or other daily activities after treatment.

Its important to remember Botox isnt a quick fix for migraine. It often takes 2 or 3 treatments to notice if its effective in reducing the frequency or intensity of your migraine pain. Botox treatment is repeated every 12 weeks, which means it may take 69 months to notice any difference. Some people have reported improvements after their first treatment, so like many migraine treatments results are very individualised.

Many people report the benefits of Botox start to wear off after about 10 weeks, and the intensity and frequency of their migraine attacks increase close to their next treatment date.

You dont need to stop taking other preventative medications with Botox treatments and you can continue to use abortive medications if you need them.

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Application Of Botox Injections For Migraines:

  • The application of the Botox injection, using a small needle, takes about 20 minutes.
  • 31 injections are included in each treatment, which is applied in 7 areas of the neck and head.
  • 6 months are needed for the effect of the treatment to be visible, meanwhile one can continue the normal medication without the fear of any interference between them.
  • The treatment can be administered to the adults above the age of 18. Since it is considered off-label when used for the treatment of children or adolescents, the insurance companies may not pay for it, in spite of being prescribed by the doctors.

Doses And Injection Sites

BOTOX for Migraines, Animation.

The first studies with BoNT injections in headache and migraine used a variety of different dosages, concentrations and injection sites for BoNT. In 2010 the PREEMPT study group developed an injection paradigm based on various studies conducted in patients with EM, CM and tension-type headaches. The PREEMPT injection paradigm combines two different approaches for the injection of BoNT in migraine: fixed injections sites and follow the pain injection sites. Fifty MU of onabotulinumtoxinA are diluted with 2.0 ml of saline, yielding a concentration of 5 MU/0.1 ml. Each intramuscular injection site is injected with 5 MU onabotulinumtoxinA. The injection paradigm consists of 31 fixed sites in the following muscles: mm. frontalis 20 MU , mm. corrugatores 10 MU , m. procerus 5 MU , mm. occipitalis 30 MU , mm. temporalis 40 MU , mm. trapezii 30 MU , cervical paraspinal muscle group 20 MU . In these fixed sites a total dose of 155 MU onabotulinumtoxinA is applied. Additional 40 MU can be administered into temporalis , occipitalis or trapezius muscles , receiving a maximum of 195 MU .

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Who Cant Have Botox For Migraine

BOTOX is only for chronic migraine: not any other sort of migraine.

People who are pregnant or breastfeeding may not have BOTOX.

If you have other neurological disease, for example Bells palsy, a neuropathy, or Myasthenia Gravis, the risks of BOTOX are increased.

If you have recently had cosmetic botulinum toxin then the side effects could be increased.

Tell your doctor if you:

Have had problems with injections in the past

Have had problems with previous botulinum toxin injections

Have inflammation, weakness or wasting of the muscles/skin where your doctor plans to inject

Have had problems with swallowing or food or liquid accidentally going into your lungs, especially if you will be treated for persistent muscle spasms in the neck and shoulders

Suffer from any other muscle problems or chronic diseases affecting your muscles

Suffer from certain diseases affecting your nervous system

Have an eye disease called closed-angle glaucoma or were told you were at risk of developing this type of glaucoma

Have had any surgery that may have changed the muscle that is being injected

Will have an operation soon

Are taking any blood thinning medicine

Botox Active Drug Form And Administration

Botox contains the active drug onabotulinumtoxinA. Its made from a toxin thats produced by Clostridium botulinum bacteria. Botox is a type of drug called a neurotoxin.

Botox comes as a powder inside single-use vials. Its mixed into a solution and given as an injection by healthcare providers. Botox is available in two strengths: 100 units and 200 units.

For most of its uses, Botox is given by intramuscular injection . Its injected into muscles in different areas of the body, depending on the condition being treated.

For OAB and urinary incontinence due to nerve disorders, Botox is injected into the detrusor muscle of the bladder. This injection is done using a thin tube called a cystoscope thats inserted into the bladder.

And for excessive underarm sweating, Botox is injected into the skin of the armpit.

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Can I Combine Botox And Cgrp Antibodies My Insurance Company Refuses To Cover Both And My Physician Told Me I Have To Choose One

CGRP monoclonal antibodies are a new class of treatment for the prevention of migraine. They can be used for Chronic but also Episodic Migraine. Read more here.

Medically, both treatments could be combined. There are reports that this combination might be effective for some people with Chronic Migraine. To read more about the BOTOX®/CGRP MAB combination see here.


How Does Botox Treat Migraines

Botox for Migraines

Botox is an injectable drug that is made from a toxic bacterium known as Clostridium botulinum. Botox treatments for chronic migraines are usually administered once every twelve weeks. During the procedure, a doctor will inject several doses of the medicine at specific points: temples, bridge of your nose, forehead, upper back, and back of the head. The goal of the injections is to reduce migraine symptoms, including sensitivity to sound, light and smell, vomiting, and nausea.

Relief does not happen immediately it may take 10-14 days for any noticeable improvement to occur. Moreover, some people do not feel any relief after the first set of injections. For such people, additional treatments may be necessary.

How does it work?

It blocks the release of neuro-transmitters, which are linked to causing pain. Botox blocks these signals from reaching your CNS and causing your nerves to be very sensitive. Only a trained professional should administer Botox injections. Make sure that the doctor is trained is giving Botox injections for chronic migraines, not for wrinkles. The treatment does not take up much of your time it takes about 15 minutes. Therefore, you can schedule it no matter how busy you are.

Is Botox right for you?

Talk to your doctor about Botox

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Management And Pharmacologic Treatment

Diagnosis of CM is based on the patients history and neurological examination. In some patients, cerebral magnetic resonance imaging and lumbar puncture might be necessary in order to rule out secondary causes for headaches .

The main goal in the treatment of CM is to reduce the impact of migraine on patients lives. Therefore, it is necessary to keep migraine attacks as rare, short and as less-impairing as possible. Various nonpharmacological measures are useful to prevent migraine attacks: trigger avoidance , dealing with risk factors .

Pharmacological treatment of CM is based on two pillars: abortive treatment of acute migraine attacks and prophylactic treatment. The substances most commonly used for the abortion of migraine attacks are nonsteroidal anti-inflammatory drugs and triptanes. There is good clinical evidence, that both substance groups are effective in the abortive treatment of acute migraine attacks. On the other hand, it has been shown, that both NSAIDs and triptanes may lead to medication overuse headaches. Therefore, the challenge is to restrict migraine-abortive substances to the least amount necessary. This observation highlights the special importance of prophylactic treatment in patients with CM. Generally, prophylactic medication can be given as soon as the diagnosis of CM is established. The choice of which substance is applied should be made with regard to the patients comorbidities .

Botox Treatment Possible Risks

The most common complaints after Botox treatment for chronic migraines are neck pain and headaches. You can use an ice pack or over-the-counter pain relievers to reduce this discomfort.

Allergic reactions to Botox can occur, but they are very rare. Seek immediate medical attention if you experience:

  • Hives
  • Shortness of breath
  • Swelling of the lower legs

There has never been a confirmed case in which Botox from an injection spread to other parts of the body. However, because botulinum is a neurotoxin, this is theoretically possible and could be life-threatening.

Seek emergency medical attention if you experience any of the following after receiving the injections:

  • All-over muscle weakness or loss of strength
  • Double vision or blurred vision
  • Drooping eyelids
  • Trouble speaking, swallowing or breathing

Read Also: Acephalgic Migraine Mayo Clinic

How Does Botox Work For Chronic Migraines

Botox is the neurotoxin botulinum toxin. The paradigm for the inject delivers Botox into nerve endings at the scalp, neck, and shoulders to both the inflamed coverings of the brain and essential neurological pathways to help stop the chronic migraine process and prevent the onset of a migraine.

Treatment with Botox is typically available if you suffer from chronic migraine pain at least 15 days or more a month. If you develop migraines less frequently, the team can recommend other treatments and preventive options.

Some Clinicians Will Prescribe Botox For High

Botox For Migraines

“I think clinical experience trumps any meta-analysis,” said Dr. Robert Cowan. “High-frequency episodic patients who failed multiple preventive therapies were not specifically studied in the PREEMPT trial, but my clinical experience has shown Botox to be equally effective for HFEM and Chronic Migraine.”

What about tension headaches? Dr. Cowan warns, “However, I strongly doubt Botox would be effective or appropriate for episodic tension-type headache.”

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Botox Is A Purified Neurotoxin Complex Protein Produced From The Bacterium Clostridium Botulinum

BOTOX is used in adults who have 15 or more migraine headaches per month lasting 4 or more hours per day.

What is Chronic Migraine?

Chronic Migraine is defined as:

  • 15 or more headache days per month over 3 months, with 8 headache days meeting criteria for migraine with or without aura.
  • To meet criteria for migraine, the patient experiences two of the following symptoms:
  • Headache on one side of the head only
  • Headache throbs or pulses
  • Headache is moderate to severe in pain intensity
  • Headache is aggravated by, or causes avoidance of, physical activity and is accompanied by either nausea and/or vomiting or sensitivity to light or sound.
  • Additionally, the migraine sufferer will have treated their headache with migraine medication prior to the expected development of the symptoms listed above.

How is BOTOX administered?

BOTOX is injected by needle into several head and neck muscles that may be causing or contributing to your headaches. The radiologist determines the number of injections and the sites required to treat your specific condition.

How often do I have to get BOTOX injections?

It is recommended that you get your BOTOX injections every 12 weeks. You may continue this therapy, if deemed effective, after discussing with your practitioner.

Can I be treated with BOTOX for chronic migraine if I am receiving BOTOX treatment for another condition?

What Happens Next

After your session is over, youll probably be able to go about your day as usual without any downtime.

But be aware that it can take a few weeks to feel relief. You should also be prepared to repeat the treatment several times. Receiving treatment once every 3 months is pretty common.

Some people will only need a few treatments to see long-lasting relief while others need the treatments more regularly to keep migraine pain under control. Your doctor will develop a personalized treatment plan with you.

Botox treatments for chronic migraine are generally considered safe.

When side effects occur, theyre generally minor and include:

  • neck pain

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How Does It Work

As a neurotoxin, Botox travels into your nerves where it alters the release of certain neurotransmitters that carry signals between your brain cells. That disruption is why this toxin can be so dangerous if you take it orally. It can even lead to paralysis.

But in small, injectable amounts, research suggests that this same process can lessen migraine pain by blocking the release of pain-producing chemicals . That interruptions how researchers think this process could help ease the pain caused by chronic migraine.

It also can help reduce other migraine symptoms, like:

  • nausea
  • vomiting
  • sensitivity to lights, sounds, and smells

FYI: Researchers dont think Botox can cure migraine. It wont be able to address the underlying cause of a chronic migraine condition.

The Dl On Using Botox For Migraine

Five Questions with Dr. Miller About Botox for Migraines ...

Botox is a protein made from the Botulinum toxin, which is produced by a rod-shaped spore forming bacteria called Clostridium botulinum.

Can the same neurotoxin that causes botulism actually be good for you? In some situations, yes. In small, injectable doses, Botox is considered a safe drug. In fact, its approved by the Food and Drug Administration to treat chronic migraine in people that experience migraine episodes 15 or more days a month.

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Do Botox Treatments For Migraines Have Side Effects

Immediately following your treatment, you can return to your usual activities without limitations.

You may have some discomfort at the injection sites, which should resolve without additional treatment. The team recommends using over-the-counter pain relievers and ice packs to alleviate your discomfort.

Botox also doesnt interfere with other medications youre taking for existing medical conditions. You can use it safely without concern for drug interactions.

Learn more about Botox injections as a preventive treatment for chronic migraine headaches by scheduling a consultation with The Center for Neurology and Neurophysiology online or by calling the office nearest you.



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