I'm hoping you can help me with some information. My neurologist suggested Botox for migraine prevention. After a long battle, we finally got approval from my insurance company, and I got the injections. Other people had mentioned somewhere around 30 injections, so when my doctor only did 13, I asked him about it. He said he knew what he was doing and that other doctors give too many injections. Is this true? Also, my injections were done 10 weeks ago, and I'm not seeing any difference. Could this have anything to do with the number of injections? Thanks for any information you can give me. Tiffany.
We'll be polite and say that your neurologist is mistaken. The standard protocol for Botox for chronic Migraine includes 31 injection sites. The diagram below shows the various injection sites and how many units of Botox should be injected into each one of them.
In some cases, minor adjustments can be made to the sites and number of units at each site, but unless there's a reason to not use a particular site, it should be included.
Yes, if Botox is not administered to the correct sites, that can definitely impact its effectiveness. On the other hand, it's not unusual to have no response to the first treatment, then have a response to the second one, administered 90 days later. This is why it's recommended that Botox treatment be tried twice before judging its effectiveness.
Has your doctor been trained to administer Botox for Migraine? This is very important because the chronic Migraine protocol is different from all other protocols for administering Botox. This is something to ask any doctor before allowing them to administer Botox. The fact that your doctor is a neurologist doesn't mean that he's been trained in administering Botox for chronic Migraine, and it doesn't mean that he's a Migraine specialist.
If your doctor isn't receptive to questions, or isn't trained to administer it, it may well be time for a new doctor, and seeking care with a Migraine and headache specialist could be beneficial. It’s important to note that neurologists aren’t necessarily Migraine and headache specialists. Take a look at the article Migraine and Headache Specialists - What's So Special? If you need help finding a Migraine specialist, check the Find a Health Care Specialist on the ACHE web site and the listing of certified specialists on the Migraine Research Foundation site.
Thanks for your question,
John Claude Krusz and Teri Robert
About Ask the Clinician:
Dr. Krusz is a recognized expert in the fields of headache and Migraine treatment and pain treatment. Each week, he and Lead Expert Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about Dr. Krusz or more about Teri Robert.
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Published On: April 15, 2014