Peter Karlsberg, MD

In my 19  years of experience injecting Botox, my patients rarely get any bruising (hemorrhage).  By injecting superficially (close to the skin surface) and by visualizing the blood vessels so that I can avoid them, bruising is seldom a problem.  I do encourage my patients to avoid aspirin, ibuprofen (Advil, Motrin), naprosyn (Alleve) and alcohol for several days prior to their appointment, but I believe that superior technique is more important than the avoidance of these "blood thinners" prior to the injections.  
When bruising does occur, remedies like Bromolaine and Arnica by mouth can make the bruises disappear faster, but bruising can still last from 7 to 14 days.  Tenderness or pain accompanied by bruising usually means that a large amount of bleeding has occurred and that you should question the expertise of your injector.
Contrary to popular belief, even among physicians and other Botox and filler injectors, applying ice before injecting anything into the face actually increases the risk of bruising by causing the facial blood vessels to open up (dilate). Ice reduces the pain of injections, but good injection technique should be next to painless.   Ice use after bruising may reduce the pain of the bruise, but in fact the use of warm compresses after bruising makes the bruises go away faster by causing them to liquify and be absorbed more quickly by the body.
Finally, the use of a good pulsed dye laser has been shown to make mild bruises resolve a little more quickly, but choosing a skilled and anatomically knowledgeable physician in the first place is the best way to avoid bruising, hemorrhage, and pain.  
Above all, be an informed consumer:  It's not Botox that causes bruising, but rather the skill of the physician on the other end of the needle!

Many of my Botox Cosmetic patients report that they experience relief from their migraine headaches when their Botox is in effect and that their migraines return when their Botox wears off.  Botox Therapeutic, the same active neuromodulator found in Botox Cosmetic, is FDA approved for the treatment of Migraine headaches and is successful in some, but not all, migraine headache sufferers.  I agree that your Botox did not cause your migraines, but that your headaches developed as a result of allowing the Botox to wear off.


There is a great deal of debate among physicians and even among neurologists regarding the differences, and potential common link or overlap, between true migraine headaches and the much more common "tension" headaches:  Tension headaches are typically a consequence of prolonged contraction or spasm of the muscles of the head, neck and face, and they are often relieved by everthing from massage, stress reduction, physical therapy, improved ergonomics at work (for example, improving the position of the shoulders, head and arms while using a keyboard for many hours a day), muscle relaxants, and even meditation, but also Botox.  
One unifying theory of the relationship between migraine and tension headaches is that, although the originating causes of true migraine headaches are typically different, often the final common pathway toward the experience of pain with migraine headaches is the spasm of the muscles of the head, neck and face.  This is the likely reason why Botox alleviates the symptoms of many who suffer from true migraine headaches.  You may have migraine headaches relieved by Botox, or you may have tension headaches relieved by Botox.  Either is possible, and if Botox works well for you, then it may be the treatment of choice.  But I would also recommend that you have your eyesight evaluated by an ophthalmologist:  You may be squinting, or fretting your brows, in order to see things up close more clearly, in which case having corrective lenses may help solve your problem as well!
I wish you good luck, and be an imformed patient above all.
Peter Karlsberg, MD