Botox Injection for Chronic Migraine:
Botulinum toxin A (Botox) has been approved by the Federal Drug Administration for treatment of chronic migraine. The administration of botulinum toxin A is accomplished by injecting a small amount of medicine into the muscles of the head and neck. Any benefits resulting from Botox tend to wear off after about 3 months with a repeat injections required if benefit is to be maintained. Injections are done every 12 weeks with maximal effect peak achieved after approximately 24 weeks.
The potential side effects of Botox used for chronic migraine include:
- Temporary, and usually mild, facial weakness with facial injections
- Temporary, and usually mild, head or neck weakness with head/neck injections
- Reduction or loss of forehead facial animation due to forehead muscle weakness
- Eyelid drooping (ptosis)
- Pain at the site of the injection or ecchymosis (black and blue mark) at the site of injection
- Dry eye
- Double vision
- Potential unknown long-term risks
It is also possible that as with any injection, there may be an allergic reaction or no effect from the medication. Reduced effectiveness after repeated injections is sometimes seen and rarely infection at the injection site may occur. All care will be taken to prevent these side effects. If therapy is given over a long time, atrophy and wasting in the muscle injected may occur. Occasionally patients become refractory (no longer effective) to treatment because they developed antibodies to the toxin and in this event, therapy needs to the modified.
Botox Injection Protocol
- Injection Appointment:
This is strictly a procedure visit, you will need to schedule a separate appointment for anything other than Botox injections. Once you check in you will be given a consent form to review and sign. The Botox injections generally take between 10-15 minutes. The injections will be performed by the Physician Assistant. You may wear your normal clothing. Please have your hair pulled up. It is ok to resume normal activity (work, driving, etc.) after your injections as tolerated. Do not rub your injection locations 2 hours after injection.
- Follow-Up Appointments and Treatments:
You will schedule a follow up appointment 4-6 weeks after Botox injections to discuss your response to the medication and other medication management if needed. You will be scheduled for Botox injections every 12 weeks. If you are unable to maintain a 12-week injection regiment the Botox will not be beneficial and as such we recommend you do not enroll in the program. Please do not leave the office until you have confirmed a date that works for you and also fits within your treatment regimen.
How You Can Help:
You play an important role in your treatment. Below is a list of things you
can do to be an active participant in your treatment plan:
- Notify us immediately of any changes in your insurance
- Keep scheduled appointments and notify us as soon as possible if you need to change your appointment
- Respond promptly to requests from the practice and others such as Specialty Pharmacy, to avoid treatment delays
How We Work With Your Health Plan
Prior to treating you with Botox, we must first receive approval from your insurance company. We will submit information to your insurance company that was gathered during your first visit with the Physician. As part of the process, we confirm plan coverage and benefits including co-pays, co-insurance, and deductible amounts. This can take 2 to 4 weeks depending on your health plan. Some plans require additional information from the clinic and may require separate approvals for the injection procedure and the drug.
Specialty Pharmacy: ** Your Responsibilities**
In most cases, we will need to obtain the Botox medication through a Specialty Pharmacy. If this is required:
- The Specialty Pharmacy may call from an unidentified toll-free number
- It is important to answer the call to verify your insurance information and pay any balances over the phone. This is a normal procedure for Specialty Pharmacy’s.
- Your prescription will not be filled until you speak with the Specialty Pharmacy.
- Your treatment can be delayed if you do not speak to a Specialty Pharmacy
- If you have not been able to take the call to verify your insurance information, you can call your Specialty Pharmacy personally. Ask Angie Perez for their number