Botox for migraines. Why can't my doctor put the injections into my 11s?

Question

I asked my doctor if he could inject Botox for my migraines in my "problem" areas (my bad 11's). He said no BC he's not trained to inject in those areas. The Botox works wonders for my migraines, but I'd also like to get the full benefits of the Botox. He also said I can't go outside Kaiser to get Botox BC my body will eventually start to reject the medication. Can't he put the injections into my 11's so I can have the best of both works? I don't understand what training he needs? Thank you!!

Yannis Alexandrides, MD, FACS · Answer

One of
  your problems is aesthetic, whereas the other is medical. Treating your
  migraines with Botox is a medical solution, and the 11's are an aesthetic
  concern. Different areas are injected for different concerns and your Doctor''s technique lies within administering the substance for medical
  reasons only. To inject your 11's would be unethical and could cause you
  further aesthetic problems. If they are not trained in this technique, they
  wouldn't know where the Botox should be injected or how much of the substance
  they should be using. As a result, you could end up with a very unnatural,
  asymmetrical appearance and the possibility of droopy eyelids. To get the
  best of both worlds you would have to see a specialist aesthetic
  practitioner to address the 11's separately. Think of it like this... you
  wouldn't put your pinks in the washing machine with your whites just because
  they use the same substance and the same machine.

Camille Cash, MD · Answer

Botox can be used both to treat medical concerns as well as cosmetic concerns. If your injector has not been trained it is best to see another injector for the cosmetic portion.  Some insurance carriers will cover Botox for medical reasons, but the cosmetic treatment is not. Having the cosmetic treatment will not cause your body to "reject" the migraine treatment.

Michael R. Macdonald, MD · Answer

Your Kaiser plan cover's the area for medical necessity. When you start to have the injections for cosmetic purposes you would likely need to pay an out of pocket cost.  It is possible that the doctor is not comfortable with the cosmetic application.  In that case, I'm sure you could find a well trained doctor or nurse injector that can take care of the cosmetic "11's", you'll simply have to pay for it.  Be well!

Jason Emer, MD · Answer

Treating migraines with Botox generally means Botox can be injected into the forehead, around the ear, back of the head, and neck muscles. I'm not sure what you mean by your body will eventually reject the medication. It may be that your Doctor isn't trained in treating the glabella area cosmetically, which requires a specific series of injections. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Rick Balharry, MD · Answer

thanks for your enquiry. this sounds a little confusing as part of the protocol for treating migraine with botulinum toxin includes the muscles in the forehead, which would treat the 11s. In fact, it was the Drs. Carruthers, in Vancouver who noticed that treating the forehead for cosmetic reasons caused a reduction in headaches in their patients with migraine - then it was introduced as a treatment for migraine. so, for the treatment to have its best results, this area should be included in your treatment.

Botox for migraines. Why can't my doctor put the injections into my 11s?

Answers (5)