How many Botox injections for chronic migraine?

Health Professional

Full Question:

I've now had botox twice for my migraines without much improvement. My doctor gives me 12 or 13 injections. I've read online that there are usually 31. How important is it that the standard 31 injections be used? My doctor won't discuss why he uses so many less. Should I go to a different doctor? Thanks for any advice you can offer. Laurel.

Full Answer:

Dear Laurel:

The only protocol with FDA approval and the best evidence is for the 31-injection protocol from the preempt clinical trials. In fairness, many of us who use Botox have slight modifications to this protocol, or modify it based on a patient's response. So not everyone getting Botox for chronic migraine needs the exact same thing. Prior to the preempt trials, just about everyone had their own way of giving it. Different doses, different locations, etc. We all thought we were doing the right thing. Once the trials were completed, many of us altered to fit closely to the protocol. Not everyone did. There may be good reasons for this, so just the fact that your doctor does it differently isn't the problem. The problem is the unwillingness to talk with you about your concerns and why what you're getting is different than the approved protocol.

So if you change doctors, do it because of the poor communication, not the style of botox injections. But remember this: if you aren't getting the standard approach to botox, you aren't a non-responder. You need to at least get the 31 injection, 155 unit protocol on two occasions three months apart to decide if botox will work for you. Below is a diagram of the 31 injection sites. You may find it helpful when you talk with your doctor.

Thanks for your excellent question,
David Watson, MD, and Teri Robert

About Ask the Clinician:

Dr. David Watson is a UCNS certified migraine and headache specialists and director of the Headache Center at West Virginia University. He and Lead Health Guide Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about _ Dr. Watson_ or more about _** Teri Robert** _.

If you have a question, please click** HERE. Accepted questions will be answered by publishing the answers here. Due to the number of questions submitted, no questions will be answered privately, and questions will be accepted only when submitted via THIS FORM**. Please do not submit questions via email, private message, or blog comments. Thank you.

**_Please note: We cannot diagnose, suggest specific treatment, or handle emergencies via the Internet. Please do not ask us to diagnose; see your physician for diagnosis._** For an overview of how we can help and questions we can and can't answer, please see _**[Seeking Migraine and Headache Diagnoses and Medical Advice](http://www.healthcentral.com/migraine/c/9924/162100/migraine-headache-diagnosing)** _.

We hope you find this general medical and health information useful, but this Q & A is meant to support not replace the professional medical advice you receive from your doctor. For all personal medical and health matters, including decisions about diagnoses, medications and other treatment options, you should always consult your doctor. See full Disclaimer.

Follow Teri on or

Follow Dr. Watson on