The recommended dilution is 200 Units/4 mL or 100 Units/2 mL, with a final concentration of 5 Units per 0.1 mL (see Table 1). The recommended dose for treating chronic migraine is 155 Units ad ministered intramuscularly using a sterile 30-gauge, 0.5 inch needle as 0.1 mL (5 Units) injections per each site. Injections should be divided across 7 specific head/neck muscle areas as specified in the diagrams and Table 2 below. A one inch needle may be needed in the neck region for patients with thick neck muscles. With the exception of the procerus muscle, which should be injected at one site (midline), all muscles should be injected bilaterally with half the number of injection sites administered to the left, and half to the right side of the head and neck. The recommended re-treatment schedule is every 12 weeks.
Botulinum toxin is one of the most poisonous substances known to man. Scientists have estimated that a single gram could kill as many as 1 million people and a couple of kilograms could kill every human on earth. In high concentrations, botulinum toxin can result in botulism, a severe, life-threatening illness. Botulism, left untreated, may result in respiratory failure and death. Despite botulinum toxin being so toxic, Botox is in huge demand.
Think about it this way: people make facial expressions every single day, whether it's expressing an emotion (i.e. smiling) or simply out of habit (i.e. raising your brows). Making facial expressions causes temporary dynamic lines to show up in your face. These lines go away when your face returns to rest. However, as you continue to make facial expressions, day after day and year after year, and as your skin ages, these lines start to get etched in your skin. That's when frown lines get progressively deeper for people who frown all the time. Or when crow's feet stay put even after you stop smiling or squinting. Eventually, what once were dynamic wrinkles become wrinkles that are just there, even when you don't make any facial expressions.
Botox for migraines has been something that has flown under the radar, as many people know Botox as a procedure simply aimed at hiding fine lines. We turned to Matthew S. Robbins, MD, director of inpatient services at Montefiore Headache Center and the chief of neurology at the Jack D. Weiler Hospital, Montefiore, to break down the procedure for us. Scroll down to see what he has to say.
Botox, or onabotulinumtoxinA, is used for three main purposes: muscle spasm control, severe underarm sweating and cosmetic improvement. In this article we concentrate on the third use, achieved with the product called Botox Cosmetic, which contains botulinum toxin type A (the active ingredient), human albumin (a protein found in human blood plasma) and sodium chloride.
Jump up ^ Arnon SS, Schechter R, Inglesby TV, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, Fine AD, Hauer J, Layton M, Lillibridge S, Osterholm MT, O'Toole T, Parker G, Perl TM, Russell PK, Swerdlow DL, Tonat K (February 2001). "Botulinum toxin as a biological weapon: medical and public health management". JAMA. 285 (8): 1059–70. doi:10.1001/jama.285.8.1059. PMID 11209178.

Beware of Botox injections at a "Botox party" at someone's house. You need to be in a medical setting, where any side effects can be treated immediately. You may not see the final effects of the injections during the party anyway, as they usually take a few days. A Botox party isn't such a bad idea if it's held by a doctor in a medical setting, but even then there's a risk of the doctor's attention being divided between you and the other attendees.


The overall cost of  the injection is charged either at a flat rate or per unit. In terms of per unit, the overall cost of the treatment will depend on the total volume or a total number of units used in the procedure. But service charged at a flat rate depends on the area to be treated. The most expensive area is around the underarm for treating hyperhidrosis.
But it could be something else altogether. In 2008, Matteo Caleo, a researcher at the Italian National Research Council's Institute of Neuroscience in Pisa, published a controversial study showing that when he injected the muscles of rats with Botox, he found evidence of the drug in the brain stem. He also injected Botox into one side of the brain in mice and found that it spread to the opposite side. That suggested the toxin could access the nervous system and the brain.
The one side effect that we most commonly see with Botox for migraine, ironically, is increased headache pain in the days immediately following the injections. Interestingly, some patients have the opposite effect, noticing immediate pain relief. That may be due to an acupuncture-like response, where poking needles into unhappy muscles actually makes them feel better.
Other adverse reactions that occurred more frequently in the BOTOX group compared to the placebo group at a frequency less th an 1% and potentially BOTOX related include: vertigo, dry eye, eyelid edema, dysphagia, eye infection, and jaw pain. Severe worsening of migraine requiring hospitalization occurred in approximately 1% of BOTOX treated patients in Study 1 and Study 2, usually within the first week after treatment, compared to 0.3% of placebo-treated patients.

"Neurotoxins and facial fillers are my most popular injectable treatments," notes Zeichner. "Neurotoxins like Botox and Dysport relax muscles under the skin that can lead to folding and lines, specifically frown lines between the eyebrows. Facial fillers are my favorite cosmetic procedure in the office—there's really an art to it. I exclusively use hyaluronic acid fillers because they are safe and long-lasting."


In two double-blind, placebo-controlled trials in patients with detrusor overactivity associated with a neurologic condition (NDO-1 and NDO-2), the proportion of subjects who were not using clean intermittent catheterization (CIC) prior to inject ion and who subsequently required catheterization for urinary retention following treatment with BOTOX 200 Units or placebo is shown in Table 9. The duration of post-injection catheterization for those who developed urinary retention is also shown.
This product contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturi ng processes, it carries an extremely remote risk for transmission of viral diseases. A theoretical risk for transmission of Creutzfeldt -Jakob disease (CJD) is also considered extremely remote. No cases of transmission of viral diseases or CJD have ever be en reported for albumin.
The patient is placed in a somewhat raised position on the exam table, and the areas to be injected are cleansed with a nonalcohol cleanser, such as Hibiclens or Betadine. Some physicians will apply a topical anesthetic, such as EMLA cream or some alternative, at this time. The Botox is then injected into the desired areas. Typical injection patterns include about four or five areas on each side of the forehead and two or three areas on either eye area. More areas can be injected by skilled physicians, depending on the type of wrinkles and the desired effect for the patient. It is common for pressure to be applied if an area seems to be bleeding after the injection. While ice is sometimes applied beforehand for comfort reasons, direct pressure is much more effective than ice for control of bleeding and bruising.
Many times, effects on spasticity are longer lasting. It is not clear if this is due to breaking down patterned movements (many muscles contracting together rather than singly) or from allowing weak muscles to get stronger over time (that were overpowered before by more spastic muscles pulling against them). It is vital to have close follow-up after the injections to figure out the best course of treatment.
I would caution against shopping around for cheap Botox. There are practitioners than offer bargain prices that are not sustainable from a business standpoint. They may be diluting their Botox or injecting less units than advertised.  Also, some practitioners charge less per unit of Botox but inject significantly more Botox than is required to achieve the optimal outcome. For instance, 60 units of Botox at $10/unit is more expensive than 45 well placed units at $12/unit. 

Before using this medication, tell your doctor your medical history, especially of: bleeding problems, eye surgery, certain eye problem (glaucoma), heart disease, diabetes, signs of infection near the injection site, urinary tract infection, inability to urinate, muscle/nerve disorders (such as Lou Gehrig's disease-ALS, myasthenia gravis), seizures, trouble swallowing (dysphagia), breathing problems (such as asthma, emphysema, aspiration-type pneumonia), treatment with any botulinum toxin product (especially in the last 4 months).
Unlike a face lift or other kind of invasive facial rejuvenation procedure, treatment takes minutes and requires zero downtime. Using a very fine needle, Botox is injected into the facial muscles that are responsible for unsightly wrinkles and fine lines and relaxes the muscles. The ingredients in Botox block the signal from the nerve to the muscle, and therefore reduce it’s ability to contract, and form unsightly wrinkles.
It is not always clear what is causing chronic migraines. BOTOX is a viable option for treating migraines, and it may be the most effective treatment for you. Migraines lead to extreme pain that impacts every aspect of life, from personal to professional. Migraines are debilitating and for some who suffer from the condition, bedrest is the only option. A BOTOX treatment for migraines is a simple procedure but could vastly improve your quality of life.
In November, the FDA held a two-day hearing asking for expert comment on the agency's rules concerning off-label drug use and marketing. Some said the practice paves the way for scientific progress and gives doctors and their patients much needed alternatives for hard-to-treat medical conditions. Others said that off-label drug use is primarily financially motivated and that it poses a serious threat to public health, particularly when drugs are used experimentally on children.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
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The Botox used for migraines and the Botox used for cosmetic procedures is actually exactly the same. "Basically, young and middle-aged women were getting [Botox] for cosmetic purposes, and that’s the most common person that has migraines, and that’s how they figured out it was helpful," Ravitz tells me. Women were getting Botox for aesthetic reasons and happened to notice relief from their migraine symptoms, and doctors began looking into it as a direct treatment. In fact, women are disproportionately affected by migraines — about 85 percent of chronic-migraine sufferers are women, and the condition affects 28 million in just the U.S.
In double-blind, placebo-controlled chronic migraine efficacy trials (Study 1 and Study 2), the discontinuation rate was 12% in the BOTOX treated group and 10% in the placebo-treated group. Discontinuations due to an adverse event were 4% in the BOTOX group and 1% in the placebo group. The most frequent adverse events leading to discontinuation in the BOTOX group were neck pain, headache, worsening migraine, muscular weakness and eyelid ptosis.
Not to be evasive, but the cost varies between physicians depending on how much Allergan product they purchase in a year. In general, it will probably be from $500 to $550 for a 100 unit vial. The equipment required to properly inject botox is not cheap, since it takes specialized syringes and needles that aid in precision and comfort. And properly trained staff and appropriately-medical... READ MORE
When asked how often he turns people away, Dr. Matarasso says: “I turned someone away today. I had a gentleman come in, he was an appropriate candidate anatomically, he had some deep lines in his forehead, but his expectations were unrealistic. He wanted every line erased, and I said, ‘No, you are going to look a little mask-like.’ I gave him a brochure and said, 'Go home and think about it.'”
That Groupon offer might be tempting, but Dr. Tutela recommends doing a thorough vetting of your practitioner’s history and methods before signing up for treatment. “I think it is important to ask any provider if they perform that procedure frequently, to gauge their experience,” he says. He also suggests to ask if they’ve experienced any major complications and to check their online reviews. “You can get a sense of how you will be treated and what kind of experience other patients have had,” Dr. Tutela says. “Many of those low-cost, high-volume practices are loaded with horrible reviews from disappointed patients.”
I usually charge $12 a unit for botox. The number of units depends on the site. The "eleven" lines or glabellar area I usually use 20 units. Also I used 20-30 units for the forehead. In the crows feet I use about 15 units per side or 30 units total. To give a Botox brow lift I use 5 units total. Finally to give a patient a natural smile or soften the sad look of the mouth I use about 10 units. You can calculate the math to determine the cost depending on what you would like to get. Botox cost is going to vary by location as overhead will be different in different areas of the country. Maintaining a park avenue office is much more costly than an office in New Jersey so my price may be lower than someone in Manhattan. Someone in Bucks County Pennsylvania may have lower costs and thus lower prices still.
Alternatively, bruising could occur, though is less likely, says Rowe, especially in the hands of an experienced doctor. While he says it's "dumb luck" whether or not one bruises from an injection, he also notes that good technique helps reduce the chances. Sobel says that "if you inject [the needle with Botox] too deep, very often you can hit a blood vessel and bruise." What you do after the injection can also make a difference: Take care not to rub or massage the treated areas, as this can cause the toxin to migrate.

On July 7, 2015, the company acquired the rights to the late stage CGRP migraine portfolio of Merck & Co, as well as two experimental drugs (MK-1602 and MK-8031) for an upfront payment of $250 million.[12] On August 10, the company acquired Oculeve for $125 million.[13] On August 31, the company acquired Naurex for an upfront payment of $560 million.[14] On October 19, the company acquired AqueSys, developer of ocular implants that reduce intraocular pressure associated with glaucoma, for an initial payment of $300 million.[15] On October 1, the company acquired Kythera Biopharmaceuticals, a company focused on the medical aesthetics market, for $2.1 billion.[16] On November 4 the company announced the acquisition of Northwood Medical Innovation, developer of earFold, a medical device to correct protruding ears.[17] On November 25, 2015, the company announced it would partner with Rugen Therapeutic to develop new therapies for autism spectrum disorder, rabies and obsessive compulsive disorder.[18]
Botox is administered by injection and dosing depends on the condition that it is used for. Administration of botulinum toxin with other agents (for example, aminoglycosides, curare) that affect neuromuscular function may increase the effect of botulinum toxin. There are no adequate studies of Botox in pregnant women and it has not been evaluated in nursing mothers.
Botox was introduced to the world in the late 1980s by ophthalmologists, who began using it to treat optic muscle disorders. It was approved by the Food and Drug Administration (FDA) for the treatment of moderate to severe frown lines between the eyebrows (glabellar lines) in 2002, and its popularity has soared ever since. Botox is consistently one of the top five nonsurgical cosmetic procedures performed each year.

In both studies, significant improvements compared to placebo in the primary efficacy variable of change from baseline in daily frequency of urinary incontinence episodes were observed for BOTOX 100 Units at the primary time point of week 1 2. Significant improvements compared to placebo were also observed for the secondary efficacy variables of daily frequency of micturition episodes and volume voided per micturition. These primary and secondary variables are shown in Tables 19 and 20, and Figures 5 and 6.
The most common severe adverse reaction associated with the use of BOTOX injection in patients with cervical dystonia is dysp hagia with about 20% of these cases also reporting dyspnea [see WARNINGS AND PRECAUTIONS]. Most dysphagia is reported as mild or moderate in severity. However, it may be associated with more severe signs and symptoms [see WARNINGS AND PRECAUTIONS].
The number of Botox varies from one area to another which has a direct effect on how much does Botox cost. For example, to remove crow’s feet, it requires at least 5 to 15 units per side while 10 to 30 units for the forehead lines. Therefore, each of the areas has a different volume of Botox necessary to correct the appearance which factors in the overall cost.

There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX® has been used at the recommended dose to treat chronic migraine, severe underarm sweating, blepharospasm, strabismus, or when BOTOX® Cosmetic has been used at the recommended dose to treat frown lines, crow’s feet lines, and/or forehead lines.
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