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Botox for chronic migraine, the most effective pattern and technique.

Botox for chronic migraine, the most effective pattern and technique.

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BOTOX (OnabotulinumtoxinA) FOR CHRONIC MIGRAINE; THE MOST EFFECTIVE PATTERN, TECHNIQUE, AND EVERYTHING YOU NEED TO KNOW. NOT ALL BOTOX TREATMENTS ARE CREATED EQUAL. @Neuralgroover Background Botox (Onabotulinum Toxin A) has been a game changer for the treatment of chronic migraine .

  • 4 weeks 1 day
    The above comments are really helpful. Some patients want to stop due to the side effects or not seeing any benefit immediately after the first injection. Educating the patient is the most important thing with any medication but esp in this one.
  • 1 month
    Very informative. A few comments:
    1. adjusting the injection sites "follow the pain" is often helpful but I have not found that there is one standard paradigm for injections that works for all. The other thing I have learned is that more Botox is not necessarily better
    2. I usually ask patients to try 3 series of Botox injections because there are some that really do not see benefit until after the 3rd series of injections. Once there is some benefit from Botox, it tends to improve further over time (presumably as the brain becomes desensitized).
    3. Ptosis and brow drop can occur, especially in older women. For ptosis, moving the frontalis injections higher on the forehead and reducing the amount of Botox can be very helpful. For brow drop, reducing the corrugator injections and making sure that they do not go too deep (in which case you are hitting the frontalis muscle) is often helpful.
    4. Botox frequency wears off around week 10, leaving patients struggling for 2 weeks before the next Botox and making those Botox injections quite painful (because of scalp allodynia). If that occurs, I will request Botox every 10 weeks but never more frequent than that. This is often game changing for the patient.
    5. Patient will often complain of increased pain for several days after Botox so it is important to educate them that Botox does not "kick in" for 5-10 days after injections. The pain they feel is not due to Botox but rather to the needle itself.
    6. I agree that failure of Botox with another provider does not necessarily mean failure of Botox but rather technical issues. It is not unreasonable to try another provider but it should be a headache specialist