ONABOTULINUMTOXINA is a neuro-muscular blocker. This medicine is used to treat crossed eyes, eyelid spasms, severe neck muscle spasms, ankle and toe muscle spasms, and elbow, wrist, and finger muscle spasms. It is also used to treat excessive underarm sweating, to prevent chronic migraine headaches, and to treat loss of bladder control due to neurologic conditions such as multiple sclerosis or spinal cord injury. The lowest GoodRx price for the most common version of Botox is around $602.89, 19% off the average retail price of $747.02. Compare acetylcholine release inhibitors.
"In the majority of these cases, it's the doctors at the front line who start using Botox off-label, and then we see the treatment of things we never expected the toxin to work for," says Min Dong, a researcher at Harvard Medical School who studies botulinum toxins in the lab and has no financial ties to Allergan. "I meet with physicians who are using the toxin everywhere--for diseases you would never know about."
The most frequently reported adverse reactions following injection of BOTOX for adult lower limb spasticity appear in Table 17. Two hundred thirty one patients enrolled in a double-blind placebo controlled study (Study 6) received 300 Units to 400 Units of BOTOX, and were compared with 233 patients who received placebo. Patients were followed for an average of 91 days after injection.
The 3rd Annual Migraine Moment Film Contest received a record-breaking number of film submissions this year. Each film delivered a unique message on living with migraine and how people cope with the symptoms that accompany this debilitating disease. At the 60th Annual Scientific Meeting in San Francisco earlier this year, Maria Galli was announced as the contest’s winner. Her powerful film, Invisible Hero, spoke to her strength and superhero-like qualities in fighting a disease that oftentimes makes her feel isolated and alone. In a recent Facebook Live hosted by the American Foundation, Maria Galli spoke with Dr. Bert Vargas, a Neurologist at UT Southwestern, about her experience living with chronic migraine and her outstanding work. [embed]https://www.facebook.com/americanmigrainefoundation/videos/1616373701807260/[/embed]
Botulinum toxin is a purified substance that's derived from bacteria. Injections of botulinum toxin block the nerve signals to the muscle in which it was injected. Without a signal, the muscle is not able to contract. The end result is diminished unwanted facial wrinkles or appearance. Commonly known types of botulinum toxin type A injections include Botox®, Dysport® and Xeomin®.
Botox prevents migraine headaches before they start, but takes time to work. “I look to the second and third treatments to maximize effects,” says Dr. Andrew Blumenfeld. “Patients see increasing benefit with an increase in the number of treatment cycles.” One treatment lasts for 10-12 weeks, and patients reported that two Botox treatments reduced the number of headache days by approximately 50%.

The potency Units of BOTOX are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of BOTOX cannot be compared to nor converted into units of any other botulinum toxin products assessed with any other specific assay method [see DESCRIPTION].
That said, there are a few things I'd make sure everyone knows before trying it. For one thing, it can be pretty painful. I have a pretty high pain tolerance, but getting 30 to 40 shots every three months is pretty rough — it feels a bit like getting tattooed with a bee's stinger, but once the needle is out of your skin, the pain goes away, and if it works for you, it's worth it. It's also important to know that it can take some time to work. The first treatment barely worked at all for me, and the second round took a few weeks. If you're going to try it out, be patient.
Lalvani previously worked in organizations dedicated to diabetes, breast cancer and kidney disease, but strongly identifies with our community because she is living with migraine. She recalls first getting what she thought were terribly debilitating headaches when she was 18. “I had no idea what a migraine was,” she said, “and I never saw anyone around me have a migraine, so I had no idea what I was dealing with, and no one else around me knew what I was dealing with.” Lalvani is excited to see the progress that’s been made recently in migraine care and the tremendous effort that AMF has put forth in helping advance research to produce therapies at a faster rate. As you know, the mission for AMF is to drive and support impactful research that translates into treatment advances as well as mobilize the community for patient support and advocacy.
How long the results from a Botox treatment last depends on the dosage and application. If Botox is too diluted and you don't get the proper units of Botox injected, the results might not last very long at all. If you get Botox for the wrong kind of wrinkles (i.e. static wrinkles) or an improper dose for your anatomy, you might not see much improvement either. In general, if the right amount of Botox is injected by a skilled doctor in the right muscles, Botox results can last 3-4 months.

In the mid-1990s, people who received BOTOX for other conditions reported improvement in their chronic migraine pain. A two-phase study was conducted, treating patients who averaged 20 headache days a month. They received BOTOX injections every twelve weeks for 56 weeks. At the end of that period, 70% of the patients had fewer than half the number of headaches they had before treatment. The FDA officially approved BOTOX to treat chronic migraine in October of 2010. Since then, more than 100,000 patients have been treated.
In the United States, botulinum toxin products are manufactured by a variety of companies, for both therapeutic and cosmetic use. A U.S. supplier reported in its company materials in 2011 that it could "supply the world's requirements for 25 indications approved by Government agencies around the world" with less than one gram of raw botulinum toxin.[66] Myobloc or Neurobloc, a botulinum toxin type B product, is produced by Solstice Neurosciences, a subsidiary of US WorldMeds. AbobotulinumtoxinA), a therapeutic formulation of the type A toxin manufactured by Galderma in the United Kingdom, is licensed for the treatment of focal dystonias and certain cosmetic uses in the U.S. and other countries.[30]
Finding an experienced practitioner is particularly important if you’ve never had Botox treatments before as he or she will devise an optimal treatment plan to address your forehead wrinkles. Furthermore, with an experienced, board-certified plastic surgeon you’ll be far less likely to experience any side effects like pain, bruising around the injection site, droopy eyelids, or mistakenly be administered too much Botox, leaving your face looking frozen for the next several months.
In 1950, pharmacist Gavin S. Herbert established Allergan Pharmaceuticals, Inc. Allergan focused on the discovery and development of novel formulations for specialty markets, as well as intimate collaboration with physicians and the scientific community. In 1953, Allergan produced eye drops and formulated new products such as the first cortisone eye drop to treat allergic inflammation and the first ophthalmic steroid decongestant.
Allergan plc, incorporated on May 16, 2013, is a specialty pharmaceutical company. The Company is engaged in the development, manufacturing, marketing and distribution of brand name pharmaceutical products, medical aesthetics, biosimilar and over-the-counter (OTC) pharmaceutical products. The Company operates through three segments: US Specialized Therapeutics, US General Medicine and International. The US Specialized Therapeutics segment includes sales relating to branded products within the United States, including Medical Aesthetics, Medical Dermatology, Eye Care, Neurosciences and Urology therapeutic products. The US General Medicine segment includes sales relating to branded products within the United States that do not fall into the US Specialized Therapeutics business units, including Central Nervous System, Gastrointestinal, Women's Health, Anti-Infectives and Diversified Brands. The International segment includes sales relating to products sold outside the United States. Within its US Specialized Therapeutics, US General Medicine and International operations, the Company sells its brand and aesthetic pharmaceutical products primarily to drug wholesalers, retailers and distributors, including national retail drug and food store chains, hospitals, clinics, mail-order retailers, government agencies and managed healthcare providers, such as health maintenance organizations and other institutions.
On April 6, 2016, the company announced it would partner with Heptares Therapeutics in a deal valued up to $3.3 billion to collaborate on the development of a subtype-selective muscarinic agonists for Alzheimer's disease and other major neurological disorders.[21] On April 21, the company announced the acquisition of Topokine Therapeutics for at least $85 million, gaining the phase IIb/III compound XAF5 - a treatment for dermatochalasis.[22] On August 2, the company sold its generic drugs business to Teva Pharmaceutical Industries for $33.4 billion and 100.3 million shares of Teva.[23] On August 11, the company announced the acquisition of ForSight VISION5 for more than $95 million.[24] On September 6, the company acquired RetroSense Therapeutics for more than $60 million, gaining the positive photosensitivity gene therapy treatment, RST-001. RST-001 is to be used in retinas in which rod and cone photoreceptors have degenerated over time, causing in increase in the sensitivity of light hitting the retina.[25] On September 20, the company announced the acquisition of Tobira Therapeutics for $1.695 billion[26] and, a day later, the acquisition of Akarna Therapeutics for $50 million.[27] On October 3, the company sold Anda, its generic drug distribution business, to Teva for $500 million.[28] On October 25, the company acquired Vitae Pharmaceuticals, focused on dermatology treatments, for $639 million.[29] On October 27, the company announced it would acquire Motus Therapeutics, a developer of treatments for gastrointestinal disorders, for $200 million.[30] On November 22, 2016, the company acquired Chase Pharmaceuticals for an upfront payment of $125 million.[31]
A BOTOX “treatment” consists of 31 injections to the head and neck areas, if adherence to the FDA approved protocol is followed. Except for injection into the procerus, which is in the midline, all others are paired sets of injections on the left and right sides. Muscles included are the frontalis and temporalis areas as well as the occipitalis, upper cervical paraspinals, and trapezii. The amount injected at each of the 31 injection sites is small—5 units of BOTOX in a volume of 0.1 mL normal saline or sterile water. A total of 155 units is are typically used.
Besides the volume of product used, Baby Botox is about the technique, says Doris Day, a board-certified dermatologist in New York City and author of Beyond Beautiful. "If you're very precise in where you put the product, you can use lower doses," she tells Allure. These super targeted micro injections deliver the more natural, tailored look Baby Botox is so coveted for.

In rare cases, Botox toxin can spread to areas beyond the injection site. If this happens, you may experience muscle weakness, vision changes, difficulty swallowing, and drooping eyelids. To reduce your risk of serious side effects and complications, always make sure Botox is prescribed and administered by a trained healthcare professional who has experience in using Botox.
30+ year migraine warrior, wife, mother, corporate exec turned health advocate, Paula is Migraine Again Managing Editor and Chief Encouragement Officer. She champions patient's needs as an American Migraine Foundation Board Member, CHAMP Coalition Leader, IHS Patient Advocate and co-author of CaMEO and My Migraine Voice research studies. In addition to hosting the Migraine Again Podcast and producing the Migraine World Summit, Paula is a frequent speaker at industry, health care and public policy events. She's also the Founder and CEO of the World Health Education Foundation, a 501c3. Follow her on LinkedIn or Facebook.
Serious adverse reactions, including excessive weakness, dysphagia, and aspiration pneumonia, with some adverse reactions associated with fatal outcomes, have been reported in patients who received BOTOX® injections for unapproved uses. In these cases, the adverse reactions were not necessarily related to distant spread of toxin, but may have resulted from the administration of BOTOX® to the site of injection and/or adjacent structures. In several of the cases, patients had pre-existing dysphagia or other significant disabilities. There is insufficient information to identify factors associated with an increased risk for adverse reactions associated with the unapproved uses of BOTOX®. The safety and effectiveness of BOTOX® for unapproved uses have not been established.
Botox often gets a bad rep for leaving patients looking a little frozen, but that's the fault of bad technique, not necessarily the procedure itself, explains Day. "In many places where it's not a trained aesthetic physician doing the injection, it's really just inject by number," she says. The problem with this is that no two faces, or even two sides of a face, are the same. "That cookie cutter, one-size-fits-all approach is what often gives these treatments a bad name," says Day.
Not much. Results begin to show in a couple of days and develop gradually over the course of two weeks. "I tell anyone preparing for a big event to have shots two weeks ahead of time," says Kane. Some observers believe Dysport sets in faster than Botox, but that has not been proven in a study. Patients taking medications that contain aspirin or NSAIDs can develop pinpoint blue bruising. Patients can wear makeup immediately but should avoid heavy workouts for 24 hours, says Carruthers.
I love talking about migraines. I don't do it to be a downer; I do it because talking about dealing with my chronic migraines may lead to hearing tips from another fellow sufferer, and I've tried nearly everything at this point. I've dealt with migraines for almost two decades, and as anyone who deals with them knows, having a variety of remedies in your toolbox is crucial when the pain hits.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.
Currently, to participate in ARMR, you must be a patient at one of the study’s enrolling medical centers. You can see a full list of the participating centers here. “The number of centers participating in the ARMR is growing rapidly,” Dr. Schwedt says. “There will be eight or nine centers by the end of this year, and ARMR will continue to grow in 2019.” Patients at any of the participating centers who are interested in ARMR can visit ARMR.org to learn more and can contact their clinician’s office to find out how to enroll. Once enrolled, participants answer online questionnaires, provide a blood sample, and maintain a daily headache diary. Visit the ARMR website for more information and to learn about how you can get involved in the study.

The studies using Botox for depression, like other research into Botox's off-label potential, were so encouraging that they caught the attention of Allergan. In Rosenthal and Finzi's research, 74 people with major depressive disorder were randomly assigned to receive Botox injections or a placebo. Six weeks later, 52% of the people who received Botox experienced a drop in reported symptoms, compared with 15% of the people given a placebo. "Over 50% of people responding is a high number," says Finzi. "These are people who have already tried other treatments, and they are significantly depressed."
Just because not every cosmetic Botox procedure is FDA-approved doesn't mean it's not safe and effective, if done properly. Off-label procedures are still within the standard of care, and there are tons of them. “There are so many non-FDA-approved applications for Botox,” says dermatologist Dendy Engelman, MD. “It can be used to decrease scalp-sweating (which helps prolong blowouts), correct a droopy nasal tip (called nasal-tip ptosis), fix brow asymmetry, minimize bunny lines from wrinkling your nose, decrease skin oiliness, minimize the appearance of pores...” The list goes on and on.

Safety and effectiveness of BOTOX® have not been established for the treatment of other upper or lower limb muscle groups or for the treatment of spasticity in pediatric patients under age 18 years. BOTOX® has not been shown to improve upper extremity functional abilities, or range of motion at a joint affected by a fixed contracture. Treatment with BOTOX® is not intended to substitute for usual standard of care rehabilitation regimens.
Botulinum toxin injections are one approach to the treatment of muscle spasticity. These injections can be given with ease and have minimal side effects. They can also be used in very focal spasticity problems that involve a few muscle groups. This treatment may not be right for some patients, such as patients with severe, widespread muscle spasticity, and patients with permanent muscle contractures that have become rigid.

In addition to glabellar lines, Botox is used to eradicate crow’s feet, frown lines, and lines and furrows in the forehead. Whereas treating crow's feet and forehead lines with Botox was for many years an off-label use, the toxin has since received FDA approval for both uses. Botox is also approved to treat a variety of medical conditions, including ocular muscle spasms, problems with eye coordination, severe armpit perspiration, migraine headaches, overactive bladder, urinary incontinence related to nerve damage from conditions such as multiple sclerosis and spine injury. Botox is being studied to determine if it might be useful in treating conditions such as knee and hip osteoarthritis, temporomandibular joint disorder (TMJ) and benign prostatic hyperplasia (BPH).


In the mid- to late-1990’s dermatologists were the first to report headache relief to migraineurs who were receiving BOTOX injections to reduce facial (forehead) wrinkles. Initially there was significant controversy about whether BOTOX really did help migraine patients. The use of BOTOX for treatment of tension headaches was studied and found to be no more effective than placebo. With migraines, it was more complex. In 2009 the data showed that BOTOX injected in particular areas of the head and neck in patients who met the International Classification of Headache Disorders criteria for chronic migraine provided sufficient benefit to recommend the treatment modality. In 2010, the FDA approved BOTOX for chronic migraine and recommended the protocol of injections and treatment frequency that had been successful in the studies.

If you think either of the FDA-approved anti-CGRP treatments might be right for you, speak with your primary health care provider, neurologist or headache specialist. If your medical provider isn’t aware of the treatments, don’t be afraid to let him or her know about them, or ask for a referral to a local neurologist or headache specialist. This is just the first step in advocating for the care that you deserve. To find a headache specialist in your area, consult our Find a Doctor tool. Dr. Starling believes that every person with migraine should be involved in advocacy, in order to bring awareness to the disease and break the stigma that surrounds it. She recommends that patients living with migraine get involved in advocacy organizations, such as our Move Against Migraine support community. You can also attend the annual Headache on the Hill event in which patients and providers go to Capitol Hill asking for more National Institutes of Health (NIH) research funding for migraine and other headache disorders. The next Headache on the Hill event is planned for February 11-12, 2019. Within the coming weeks, the American Migraine Foundation will be compiling a guide to all three anti-CGRP treatments. For additional information on anti-CGRP migraine treatment options, consult our doctor-verified resource library.
The potency Units of BOTOX (onabotulinumtoxinA) for injection are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of BOTOX cannot be compared to nor converted into units of any other botulinum toxin products assessed with any other specific assay method [see WARNINGS AND PRECAUTIONS and DESCRIPTION] .
"In the majority of these cases, it's the doctors at the front line who start using Botox off-label, and then we see the treatment of things we never expected the toxin to work for," says Min Dong, a researcher at Harvard Medical School who studies botulinum toxins in the lab and has no financial ties to Allergan. "I meet with physicians who are using the toxin everywhere--for diseases you would never know about."
In detrusor overactivity associated with neurologic condition patients with analyzed specimens in the drug development program (including the open-label extension study), neutralizing antibodies developed in 3 of 300 patients (1.0%) after receiving only BOTOX 200 Unit doses and 5 of 258 patients (1.9%) after receiving at least one 300 Unit dose. Following development of neutralizing antibodies in these 8 patients, 4 continued to experience clinical benefit, 2 did not experience clinical benefit, and the effect on the response to BOTOX in the remaining 2 patients is not known.
It's also not approved by the U.S. Food and Drug Administration (FDA) for depression, not that that stops doctors from prescribing it that way. Such off-label use of Botox, like that of any FDA-approved drug, is legal in the U.S. That's because once a drug has been approved by the FDA for a condition, licensed physicians are legally allowed to prescribe it for any medical issue they think it could benefit, regardless of whether it's been proved to work for that condition.

According to the PREEMPT injection paradigm, a total of 5 units of onabotulinumtoxinA is injected into each corrugator muscle. To confirm the location of the muscle, the patient is asked to furrow the brow in order to activate the corrugator. Once the muscle has been located, the muscle should be palpated and pinched by holding it between the thumb and index finger. Five units of onabotulinumtoxinA is injected at an approximate 90° angle with the bevel of the needle pointing upward into the medial belly of the muscle. As the needle is inserted, there is skin resistance, which lessens when the muscle is penetrated. This decrease in resistance is termed a muscle pop. Once the muscle pop occurs, inject into the superficial muscle. If the injection is too far superior or above the corrugator muscle, brow ptosis can occur due to depression of the medial brow as the frontalis elevating function is lost and the corrugator depressing function remains unopposed. Whereas weakening the corrugator muscle will cause elevation of the medial eyebrow, alternatively, if the corrugator injection is done too low, then diffusion to the levator palpebral muscle could lead to lid ptosis.
Headache is a universal experience. At present, there are more than 100 different types of headache and one of the most recurring ones is migraine, which affects approximately 10-12% of the population, being three times more common in women than in men. When migraine becomes chronic -occurring more than 15 days a month-, it can disrupt patients' daily life in a great degree.
Lastly, a Botox treatment does not offer permanent results. Botox is most effective when treatments are carried out at regular intervals before the results fully wear off. On average, the results last for three to four months,  although Botox metabolizes at different rates in different individuals. The first ever Botox treatment you receive may not last as long as subsequent treatments, plus you may require touch-ups two weeks after the procedure as your injector determines the right dosage for you. Over time, however, many patients notice that they can wait longer intervals between treatments as their treated facial muscles weaken.
Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing.
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