Botulinum Toxin Injections (BOTOX)

Botulinum toxin injections are often used for the treatment of chronic migraines.   Botulinum toxin is a purified toxin from clostridium botulinum that acts by relaxing muscles through its action on neuromuscular blockade, as well as blocking the release of the neuropeptide CGRP (calcitonin gene related polypeptide) from extracranial nerve terminals.  CGRP has been implicated as the major neurochemical trigger for migraine headaches.

We follow a standard injection protocol with 31 injections to the head, neck and shoulders.  The procedure is performed in the office, and is generally quick and well tolerated.  It is performed using a very small needle, and patients report that the injections feel like a pinch or prick.  Injections are typically repeated every 3 months, with improvement occurring over several weeks following the injections, although it may take 2 or infrequently 3 rounds of injections to see significant headache improvement. 

Botulinum toxin injections are quite safe, with minimal side effects.  The most common complaint following injections is posterior neck pain or discomfort.  Infrequently, there may be associated neck weakness or eye lid droop.  Our specialists are trained to perform these injections in a way to minimize these potential side effects.

There are a number of different botulinum toxins available for injection, but the most commonly used product is Botox.  Your provider can discuss the value of one product over another.