Do I Go to Dermatologist, Plastic Surgeon or Neurologist for botox migraine treatment?

I would encourage you to get a consultation with a neurologist if you've never seen one for your migraines and ask them about Botox. The number of units may be different from what many of us are accustomed to using for cosmetic reasons and the trigger points may be different in different patients.

Botox has been clinically indicated for the treatment of migraines. A conservative approach is often a good start. Raffy Karamanoukian Los Angeles

Treatment of migranes is a very individualized process. The first step is to see a qualified plastic and reconstructive surgeon that can understand and guide you through the multiple surgical and nonsurgical options. The patient must present with an active migrane. Only migranes that are triggered by compression of peripheral nerves can be treated with botox, luckily at least in my practice this includes the majority. A plastic surgeon with craniofacial experience can easily identify the possible locations of triggering and a diagnosis is made by stimulating and relaxing the muscles manually with special massage techniques or injecting a small amount of lidocaine near the triggering nerve. If the migrane is treated, the diagnosis is made and options are reviewed. The next step is to give the patient a trial of local muscular relaxation with botox administration which must not only significantly chemodenervate the local muscles, but also must be balanced through the face so as not to create an aesthetic deformity. depending on level of relief, duration of relief and patient preferences, most patients opt for a permanent treatment without recurring cost. The identified trigger nerve is decompressed in a quick in office surgical procedure and a small amount of fat is placed around the nerveto cushion and protect it from further irritation. Patient staisfaction is very high with this protocol. Remember there are many practitioners that will be willing to inject Botox for migranes who do not have the anatomical, physiological or surgical knowledge and experience to produce a result. I strongly recommend seeing a plastic and reconstructive surgeon who can guide you. All the best, Rian A. Maercks M.D.

Hi donna4fit, The FDA only recently approved the use of Botox for chronic migraine patients, even though Botox has been used for years to help headaches. Generally, migraine medication must be used first before considering Botox treatment. Various specialists use Botox for multiple reasons, including cosmetic. A dermatologist, plastic surgeon, or neurologist could provide Botox for migraines. However, your primary care physician or internist could also perform the procedure. Only after a comprehensive evaluation can help determine if Botox for migraine headache is appropriate for you. Best of luck. Dr. Chaboki

Botox is quite effective at reducing the severity and frequency of migraine headaches. We ask that patients first have a workup by a neurologist. You would not want to get Botox for headaches caused by a brain tumor or aneurysm! Botox treatments are then best optimized to the patient's physiology over time with a single caring attentive physician.

Botox works very well for the treatment of many migraines, especially those that are triggered by muscle tension. The most common areas treated are those in originating in the occipital, temporal, frontal and glabella regions. I agree that insurance coverage is most easily achieved by visiting a Neurologist. However, interestingly, many neurologists in our part of the country refer these patients for treatment. Most of the other disciplines you mentioned who perform Botox treatments can of course treat you as well. It really becomes more a matter of your insurance company covering the treatment.

Donna BOTOX for migraines is used when other standard means have not helped. You will have side effects from BOTOX for migraines. I strongly advise that if you are considering this treatment, that you should be having your migraines managed by a neurologist, rather than a dermatologist, facial plastic surgeon, plastic surgeon, or gp. The neurologist will be certain that you have been properly worked up for the migraines. They will assess your response to standard treatment and will be the most focused a rational approach to this condition. As your internist for a referral to a neurologist who provides a full range of care for migraine patients.

It is advisable to see a Neurologist first if you have not been treated with Botox in the past for migraine, and especially if you want your insurance to cover the Botox injection. If you don't use insurance, you can go to any doctor who is comfortable treating migraine with Botox.There are strict guidelines by the insurance/third party payers to determine if your treatment would be covered. Your Neurologist would make the diagnosis and determine whether you could be covered with Botox treatment. After the diagnosis, you physician would send a pre-certification asking your insurance to cover your treatment -which could be a tedious process depending on your insurance. If you are approved, your insurance would pay for your Botox injection based on your coverage contract. Hope this answers your question.

This is a very interesting question.Many people will answer it based on their personal profession as the best to address the problem.Neurologist are the specialist that know everything about headaches. They are the ones that best know how to medicate for your migraines, if that is your diagnosis.Their approach to botox for migraines (if they believe on it) is to give you tons of medication through out your face and skull to try to control the symptomes. (in my opinion an overkill). I might add that their knowledge in facial and neck anatomy is limited. Dermatologist are the specialist that know everything about your skin. They became involved with migraine treatment because of their cosmetic use of botox for facial wrinkles. Their approach to botox for migraines is limited to the ones related to the frowning muscles and maybe to the temporal area. (in my opinion an undertreatment if your case is more complex). I might add that their knowledge in neck anatomy is limited.Finally, Plastic surgeons. I know. They just make people beautiful. However, they are the ones who started the application of botox for facial cosmetics, and the ones that have developed the surgeries for the treatment of migraines.Because of their global knowledge of surgery in face and skull, their knowledge of anatomy is the most precise.The bottom line is...Not everybody is capable of doing the job. Despite of their training, the most important element to decide is the experience and the reviews that the patients give to their doctors.Hope this can guide your decision.

You can go to any of those specialists for Botox migraine treatments. Simply ask them if they perform this treatment when scheduling the appointment. It is a straightforward procedure and any of those specialist should feel comfortable with it.