Botox coverage for TMJ & migraines (insurance or rebates)

Question

I have been treated with Botox in the masseters for my TMJ and subsequent migraines for the past 5 years. I have seen a neurologist and tried a couple different medications for the migraines with no avail. I wear a night guard and see a chiropractor weekly to release the tension in my jaw, and have done so for the past few years. By far, botox in the masseters has given me the most relief. It can be quite costly and I’m curious if there is any way to reduce the cost and how to do so. Thank you!

Kurt Kuhlman, DO · Answer

You can easily get this covered under insurance for chronic migraine protocol. You have to meet criteria including over 15 headache days per month with half being migraine and you have had to try 4 different medications including an antidepressant (e.g. Cymbalta), anti seizure (e.g. Topamax), beta-blocker (e.g. Inderal) and a migraine specific abortive medication (e.g. Sumatriptan). Your provider will then have 200 units of Botox to use and 155 units have to be injected in specific areas. The remaining 45 units can then be injected into your masseter muscles to treat the TMJ. Some injectors do not know how to inject the masters so ask before if they can do this. Good luck.

Botox coverage for TMJ & migraines (insurance or rebates)

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