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What Kind Of Doctor Does Botox For Migraines

Botox And Chronic Migraine

Botox For Migraines

Many of us think of Botox injections as a way to help conceal the visible signs of ageing. But Botox has its roots in treating a range of medical conditions and is now used as a preventative for chronic migraine.

Botox works to gradually decrease the frequency and severity of migraine headaches, and for many people its an effective treatment that improves their quality of life.

Wheres My Nearest Chronic Migraine Specialist

Finding one whos right for you could be an important step in managing your treatment.

Please note: While we update our directory regularly, this list may not have current provider information. This is a list of physicians compiled by Allergan, an AbbVie company, known to have experience with BOTOX® in the past 5 years. The results shown may not be inclusive of all physicians who may have experience with BOTOX® or therapies like BOTOX® in your area. Please see the terms and conditions for additional details.

It Can Take Several Months To See Results

If you don’t experience relief from migraine right away, don’t swear off the treatment immediately. Dr. Najib recommends trying two rounds of Botox before making a decision about whether it’s working for you. Even if the treatment ends up helping after the first round, he says results typically take two to four weeks to kick in. There’s no taper required to discontinue the treatment.

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The Risk Of Side Effects Is Low

“Botox injections can occasionally trigger a headache, muscle weakness and neck pain, but this is rare,”Kerry Knievel, DO, director of the Jan & Tom Lewis Migraine Treatment Program at Barrow Neurological Institute in Phoenix, Arizona, tells Health. “Eyelid and eyebrow asymmetry and droop can happen, but to prevent this we recommend that patients refrain from rubbing their foreheads or wearing a hat for 24 hours after their injections to prevent the Botox from spreading from the area we intend for it to be.”

In fact, Botox’s limited side effects are part of its appeal. “It’s not addicting. You don’t have to take a pill every day. It doesn’t work for everyone, but it does work for a significant amount of people. That’s why Botox is amazing,” says Dr. Bashir.

How Does Botox Work

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Botox is injected around pain fibers that are involved in headaches. Botox enters the nerve endings around where it is injected and blocks the release of chemicals involved in pain transmission. This prevents activation of pain networks in the brain.

Botox prevents migraine headaches before they start, but takes time to work. I look to the second and third treatments to maximize effects, says Dr. Andrew Blumenfeld. Patients see in

creasing benefit with an increase in the number of treatment cycles. One treatment lasts for 10-12 weeks, and patients reported that two Botox treatments reduced the number of headache days by approximately 50%.

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Is It Ok To Buy Botox

Botox has been proven to be a safe and effective treatment for migraines when administered by a healthcare professional. Botox for migraines is a quick, simple procedure. You can continue about your normal day after Botox injections for migraine headaches.

Theres a growing market for Botox outside of a medical setting, though. Some tattoo parlors offer Botox injections, and its even possible to buy Botox online. This is dangerous, however.

You should only receive Botox treatments from a medical professional. Only medical professionals can get real Botox. Theres only one company in the world that makes Botox that is approved by the FDA. Only doctors can get this Botox, and doctors only treat patients with this FDA-approved Botox.

How Effective Is It

The goal is not to become completely free of headache or migraine but to improve quality of life, and to convert migraine from chronic to episodic.

About one in four patients do not respond one in four respond well to the first or second set of injections, and half need more than two sets of injections to get a good response. Studies show that 47% of patients had a 50% or greater reduction in the number of days with headache.

The biological effect of botulinum toxin on nerves takes several days or a few weeks to work. You should not expect chronic migraine to improve properly in less than 4 weeks. Some patients do not start to improve until after their second set of injections which is given 12 weeks after the first set of injections.

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How Do I Access Botox

Botox is only available on the NHS for people with chronic migraine who have tried at least three other preventive treatments. It is currently only available via a specialist such as a headache specialist or consultant neurologist.

If you think you are eligible for Botox and would like to considered for treatment you can ask for a referral to a specialist. The specialist will assess your history and symptoms to make sure Botox is an appropriate treatment option for you. You should be asked to keep a headache diary to monitor the effectiveness of the treatment.

If Botox doesnt work for you or stops working your specialist will discuss other treatment options with you.

Before Being Treated With Botulinum Toxin Type A

Botox for Migraines

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before being treated with botulinum toxin type A for migraine, make sure that your doctor knows:

  • If you are pregnant, trying for a baby or breastfeeding.
  • If you have an infection or any swelling near any of the areas that will be injected.
  • If you have any muscle problems, particularly any muscle weakness.
  • If you have ever had any difficulty in swallowing or with your breathing.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.

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Migraine Management Sometimes Requires A Team

One note of caution regarding finding care for migraine is that, sadly, there is a small but significant number of providers who promote treatments for migraine that are based on no real evidence and have the potential to do more harm than good. Some are even willing to exploit migraine patients’ desperation for help for profit.

Patients should be wary of practitioners who tout expensive “miracle cures” for migraine without hard evidence to support these therapies. Based on currently available evidence, there is no cure for migraine. However, now, more than ever before, we have many, well-tolerated, effective treatment options to manage the neurologic disease of migraine.

Things To Be Aware Of

Botox treatment is expensive if you do not qualify for PBS coverage. When covered by the PBS, the government pays the majority of the cost. The amount you pay per treatment can vary significantly and may be up to a few hundred dollars when including consultation fees.

We are aware of some neurologists charging very high fees over $500 – doctors can charge what they like, but you don’t have to pay it. Feel free to call around and find someone charging something a bit more reasonable.

Not all neurologists administer Botox, so you may need to go to a different neurologist than your normal specialist. Similarly, while it is possible to get Botox through a public neurology clinic, it will depend entirely on the availability of a trained specialist, and the wait times may be very long.

Some neurologists are also a bit pushy when it comes to Botox, offering it to new patients without discussing the options, and insisting they continue with the protocol even if it isn’t working or if patients experience significant side effects. We are also aware that some neurologists tell patients that Botox has no side effects – it does.

The general side effects of Botox are pain, tenderness, inflammation, tingling or numbness, swelling, dry mouth, redness of the skin, infection, bleeding and/or bruising at the site of injection generally feeling unwell and weakness.

Read the patient information sheet before considering this treatment and discuss it with your doctors.

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Will My Insurance Cover Botox Injections For Migraines

Since Botox is an approved treatment for chronic migraines, many insurance companies will cover some or all of the costs. This includes both Medicare and Medicaid plans. Its important to keep in mind that insurance companies will usually only cover Botox treatments if you have tried and failed two other treatments for your migraines. To verify this, they may ask that you work with your healthcare provider to submit a prior authorization form.

Like with any prescription medication, its important to work with your healthcare provider and insurance company to see what cost is covered and what you will be expected to pay out of pocket.

Using Botox For Migraines

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More than 3 million Americans suffer from chronic migraine headaches. Almost everyone experiences a headache at some point in time, but chronic migraines are migraine headaches that occur 15 days out of the month for a period of 3 months or longer. Its not entirely clear what causes migraines, but there are ways to relieve migraines. If you experience migraine headaches, Botox for migraines could be an effective treatment option for you.

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How Does It Work And How Effective Is It

Though there’s still more research to be done on Botox for migraines and doctors aren’t yet completely sure why the procedure is effective, they have some ideas. Ravitz tells me, “What does is paralyze nerve terminals. Essentially, nerve terminals transmit pain, but they also produce pain substances while theyâre doing that, and it completely paralyzes that process.” She says that it stops the process of pain patterning and it also relaxes the muscles.

According to Ravitz, it’s very effective among a large sampling of her patients and is usually very well tolerated. She says some of her patients find that it even eliminates the need for medication, which is a huge deal. However, she also says, “About 7 to 10 percent of my patients find that itâs not effective and they actually feel worse during that time.” As with any medical procedure, everybody is different and will respond to treatment differently, and it’s best to do a healthy amount of research and thoroughly talk to your doctor about your body and medical history before making a decision.

Adding Botox To Your Treatment List

Botox has been used to treat medical conditions for many decades and its an evidence-based treatment option for people with chronic migraine. Side effects are rare and mild and many peoples biggest fear are the needles.

As well as the quantitative effects Botox can have, such as a decrease in the severity and frequency of migraine attacks, theres also the little day to day things we often forget were missing out on.

Botox may help you to claim back hours previously lost to migraine, including:

  • more quality time with friends and family
  • less time off work and school
  • ability to function better during a migraine attack
  • head space to take on extra responsibility at work
  • ability to pursue a passion project.

Botox isnt a quick-fix solution for chronic migraine and if it works, you need to continue treatment every 12 weeks for ongoing benefits. Botox isnt a cure, and like other migraine treatments such as preventatives, abortives and lifestyle changes, Botox is another piece of your treatment plan.

If you qualify for Botox on the PBS and youre prepared to spend more of your migraine budget, Botox can be a great treatment option for chronic migraine that can help to give you back more migraine free days.

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What Are The Potential Side Effects

I asked this question as Ravitz was putting the first needles in my face, which was probably a mistake as I get anxious easily. However, she assured me that the side effects of Botox typically don’t happen at the doses prescribed for migraines, and even if the scary-sounding side effects you read about online do occur , they aren’t particularly dangerous and last four to six weeks.

“Most commonly, people have pain because youâre dealing with a bunch of shots, and sometimes you can get a headache from the procedure,” Ravitz tells Allure. “You may have heard about eye droops, but you usually donât see that. It can happen, but we try to keep it very symmetric so that it doesnât happen at all.”

Personally, I typically experience a headache after the procedure, but I attribute that mostly to tension and anxiety that comes from anticipating pain. It usually goes away before the next morning, and that’s the only notable side effect I’ve experienced in the five rounds of Botox I’ve had so far.

What To Expect From Getting Botox

Botox for Migraines

Botox injections themselves are almost painless. You may experience a very small sting or slight burning sensation with each injection.

Each session will last between 10 and 15 minutes. During the sessions, your doctor will inject multiple doses of Botox into specific points along your head and shoulders.

After the treatment, most patients are able to continue their day as usual without any issues.

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Clinical Evidence For Botox For Chronic Migraine

The FDA’s decision to approve Botox for Chronic Migraine was based on the existing evidence, namely two clinical trials called PREEMPT. The two PREEMPT trials included only patients with Chronic Migraine.

These two pivotal, placebo-controlled trials showed that Botox was associated with two fewer headache days a month for people with Chronic Migraine and chronic daily headache.

For episodic Migraine or tension-type headache, on the other hand, the clinical proof just isn’t there. A recent meta-analysis of 17 studies looked at data from nearly 3650 patients, of whom 1550 had Chronic Migraine and the remaining had episodic Migraine.

Ongoing Evidence To Support Botox

Further prospective and retrospective studies support the results of the PREEMPT study. The COMPEL study, which began in 2011, included 716 patients with an average of 22 headache days per month. The participants received 155 units of Botox at the 31 injection sites from the established migraine protocol every 12 weeks for 2 years. Just over half the participants completed the study and by weeks 60 and 108, there was a significant reduction in headache days reported.

In 2019, researchers reviewed the data from 211 patients who received Botox at 7 private neurology practices in Australia. The study found 74% of patients benefitted from Botox treatments, including reduced headache days and a decrease in the number of days they used acute pain medication.

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Other Specialists Who Diagnose And Treat Migraine

Migraine can be a hard condition to correctly diagnose and treat. You may need to see other medical specialists to rule out conditions that cause migraine or migraine-like symptoms. These doctors include:2-4

  • Neurologists: Doctors who diagnose and treat disorders of the nervous system. These include migraine, stroke, concussion, epilepsy, Parkinsons disease, Alzheimers, and multiple sclerosis.
  • Ophthalmologists: Specialists who treat eye disease. Many people with migraine have vision changes, loss of vision, and sensitivity to light. This means some people go to an eye doctor first. An ophthalmologist can help decide if symptoms are caused by an eye disorder or migraine.
  • Obstetrician/gynecologists: An OB/GYN treats issues of the female reproductive system, such as pregnancy and childbirth. Women whose migraines are tied to their menstrual cycle may first talk to their OB/GYN before seeing a headache specialist.

It’s A Little Different Than The Botox You Receive From Your Esthetician

Botox for Chronic Migraine  Dr. Mayhar Okhovat MD

Though the same drug is used for both migraine prevention and cosmetic purposes, the amount and placement of Botox varies depending on your goals.

You may find some level of relief when you get Botox for cosmetic purposes. However, when you receive Botox from an esthetician, you’re not getting injections in the same spots as you would in a doctor’s office. This means you’ll miss the drug’s full migraine-busting effect.

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How Long Does It Take For Botox To Work

Some patients may see improvements in their headache frequency in the first 4 weeks, but most patients who see improvements will notice them after the second injection at 12 weeks.

In 24-week long studies, patients continued to see reductions in their number of headache days on most days over the 24-week period. Botox also lowered the total length of time of headaches on days when they occurred over the study period, when compared to placebo.

Botox is not recommended for the preventive treatment of episodic migraine.

What To Expect From Treatment

If your doctor decides youre a good candidate for Botox treatment for your chronic migraine, youll receive 31 injections into the muscles under your skin.

These injections are almost painless. If you feel them at all, you might feel a small sting or slight burning sensation.

The injections will be spread out across various areas, including your:

  • forehead
  • upper bridge of your nose
  • neck
  • upper back

The exact locations will vary depending on where you feel your pain. Why can it change? Thats because your injection specialist will essentially be targeting trigger points where your individual migraine pain originates.

It only takes about 10 to 15 minutes to administer all of the injections.

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Who Had The Idea Of Trying Botox To Treat Migraine

The use of Botox for migraine came from random observations of improvement of migraine in women receiving Botox for cosmetic purposes in the 80s. Chronic migraine is common in women in their 40-50s. The benefit was reported to the company, and clinical trials were designed to see if Botox could really treat migraine.


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