Botox

Services and history

What is Botox and how is it used for migraine?

OnabotulinumtoxinA, more commonly known by the brand name Botox, is a purified biological neurotoxin produced by certain bacteria. The toxin blocks the ability of nerve cells to signal muscles to contract, thus resulting in paralysis. While initially used to treat wrinkles for cosmetic purposes, it was discovered that not only did the drug block nerve signaling to muscles, but also seemed to block pain-sensing nerves from releasing pain-causing chemicals, thereby preventing a process called neurogenic inflammation thought to be important in many types of headaches, migraine in particular.

Botox has been an FDA-approved treatment for chronic migraine for many years. The Botox protocol for migraine involves a series of 31 injections delivered with a very small needle into the tissue just under the skin. The injections locations are in the forehead, the temples, the back of the head, the neck, and the shoulders. You receive a series of injections once every 3 months.

When will I notice if Botox is helpful?

The goal is to reduce the number of days you are experiencing headaches (frequency) as well as reduce the severity and duration of headaches.

You may not find this treatment to be effective until you have had at least 2-3 sessions. After the first treatment, some patients start to notice a benefit within 4 weeks.

Keep track of your headaches on a headache calendar and make note of when you started treatment.

What are the risks and side effects?

- As with any injection into the skin, there is a risk of bleeding and infection. The amount of bleeding is typically very minor and stops within seconds after the injection. Infection is prevented by cleaning the skin with alcohol before the injection.

- The most common side effect is discomfort or pain at the sites of the injections. You may feel a small bump or swelling at the injection site, which usually resolves within hours.

- Rare but life threatening side effects include problems breathing or swallowing or spread of toxin effects.Tell your doctor or get medical help right away if you develop loss of strength and muscle weakness all over the body; double vision, blurred vision and drooping eyelids; hoarseness or change or loss of voice (dysphonia); trouble saying words clearly (dysarthria); loss of bladder control; trouble breathing; trouble swallowing.

- As with any medication or injection, an allergic reaction is possible. Symptoms of an allergic reaction to Botox may include: itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you are wheezing or have asthma symptoms, or if you become dizzy or faint.

Are there reasons I should not receive Botox?

- If you are pregnant or planning to become pregnant.

- If you have certain medical conditions such as:

- bleeding problems

- muscle or nerve conditions such as ALS or Lou Gehrig's disease, myasthenia gravis, or Lambert-Eaton syndrome

After you receive your Botox injections:

- If you have any pain or swelling, you may gently apply an ice pack but do not rub or massage the area for 24 hours.

- If you have any neck stiffness, you may gently apply a heat pack and do stretching exercises.

- You can experience pain at the injection sites, headache, and muscle pain/stiffness after your treatment. These symptoms typically go away within a few days to 1 week. Experiencing these symptoms does not mean you will not respond to Botox treatment.

- These symptoms should improve within a few days to 1 week. If they do not improve, let your doctor know.

- If you develop any muscle weakness, double vision, drooping eyelids, difficulty with speaking or swallowing, or difficulty breathing, to to the emergency room.