What is the Dosage of Botox for Use to Treat Migraines?

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.

Dosing Botox injections for migraines is an art form. I would usually start conservative to determine the proper dose for your needs. Raffy Karamanoukian Los Angeles

Neurologists, dermatologists and plastic surgeons can treat migraines with varying units.  YOur treatment will depend on what triggers are thought to stimulate your headaches.

Please keep in mind that not every one responds to BOTOX for migraines.  The dose is adjusted to your response so the dose is based on what you need recognizing that increasing dose is associated with increasing side effects.

Since Botox works to block the neuromuscular receptors, preventing a muscle from contracting, it works well in many patients to alleviate migraines.  Most migraines originate from involuntary muscle contracting or having some sort of spasm around particluar nerves.  This is why most patients with severe migraines always start at the same area and then radiate out to encompass the entire head.  If a patient can pinpoint the area, then Botox into the underlying muscle can help take the spasm away and alleviate the pressure on the nerve.  There is no defined dosage, since it really varies from patient to patient.  It also does not work for everyone, but in a majority of patients, they get good migraine relief for 3-4 months.  I hope this helps.

The dosage varies but most of the time I use 50 units. As long as the trigger points are properly addressed, I have found the dosage to be quite effective.

Botox can be a very effective treatment for migraines, and is now approved by the FDA  for this indication.  Several studies have been published on this topic.  The protocol that is referenced most frequently utilized up to 195 units injected to the forehead, temples, posterior scalp, posterior neck, and trapezius muscles.  In my personal experience, most patients respond to a much smaller dose depending on the distribution of the actual pain.

It is not a fact that botox helps with migraines but in my experience I have seen it work for a lot of my patients. Every patient is different and reacts different to treatments. Botox can be injected in a lot of different places. When I am injecting botox for a patient that is doing it for migraines I inject in the same places I do for my other patients and that would be the forehead, glabellar area, and crow's feet area.

Since every patient is different, there is no specific dosing regimen and there is no defined placement.  The dosage and placement really depends on the individual, the trigger points for the headaches, and where the headaches end up.  It's best to treat the migraine as soon as it comes on, but most of my patients are injected 2-3 times each year to keep the headaches from coming back!

I would say that most of my migraine patients take a minimum of 50 units. Some need more. But the placement depends upon where they get their migraines. People will get targeted migraine pain in different spots. Some right between the eyes, some feel a pull behind the ears, some in the temples, so it really need to be customized per patient.