OnabotulinumtoxinA is the only treatment approved by the United States Food and Drug Administration for the prevention of headaches in adult patients with chronic migraine (CM). CM assessment involves a detailed history to rule out secondary sources of headache, establish migraine features, and assess the total number of headache days. In order to diagnose migraine, the patient should have had at least five attacks that involve migraine features, as outlined below. In adults, untreated attacks usually last 4 or more hours.
It takes a village to raise a child. My family members are well aware of how I cope with migraine. They make themselves available to help my children and me often. I rely on people to drive me to doctor’s appointments as well as take my children to sports practices. I arrange carpools and am honest with the people in our lives about how a migraine attack can be unpredictable and suddenly change plans. Every year, I alert my children’s teachers of my chronic migraine and ask them to watch and listen for signs of migraine or stress in my children. I worry about them physically and emotionally and so far, they have handled my disease as they would any other illness. By being honest about the help I need, I find that the people in my life are better equipped to follow through. Many people would like to help but don’t know how. I have given up pride and allowed others to help, which inevitably takes stress away from us all.

It is not known whether BOTOX® is safe or effective to treat increased stiffness in upper limb muscles other than those in the elbow, wrist, fingers, and thumb, or in lower limb muscles other than those in the ankle and toes. BOTOX® has not been shown to help people perform task-specific functions with upper limbs or increase movement in joints that are permanently fixed in position by stiff muscles. BOTOX® is not meant to replace existing physical therapy or other rehabilitation that may have been prescribed.


Prevention of contractures begins with finding out what is limiting a child from either actively (moving oneself) or passively (being moved by someone else) moving the joints through a full range of motion. In some cases, this can be due to destruction or abnormality of the bones around a joint. It can also be due to problems with the ligaments and tissue around that joint.
Pharmaceutical companies are not without blame. One reason why insurers impose step therapy is high drug prices. Botox, which is made from the toxin of certain bacteria, is much more expensive than other migraine treatments like beta blockers, which are available as generics. Botox costs about $4,800 a year, but with injection fees, treatment can cost up to $10,000 a year. “They could lower the price,” says Loder. “Their goal is to maximize return on investment for their stockholders. That’s not the same thing as maximizing benefits for patients, unfortunately.”

Injection description is very important. It is best to describe the injections as a pinch rather than a bee sting, and to explain that the injections are shallow, with only a half-inch needle. As a result of the superficial technique used with the injections, deep anticoagulation can be continued. The procedure is short, and talking to the patient during the procedure about something other than the injections can help alleviate the patient’s anxiety. It is important to describe onabotulinumtoxinA as a purified protein rather than a toxin or a poison. In addition, stating that it relaxes muscles rather than causing paralysis will be reassuring to the patient. In a very anxious patient, the areas to be injected can be iced first or a local anesthetic cream can be applied. Starting with the trapezius muscle can also help, as these injections are the least painful, and the patient cannot see the needle. Finally, it is important to make sure the injections are performed with a sharp needle, and blunt needles are discarded. Thirty-gauge needles only remain sharp for six to eight needle sticks each.
So people told me I looked tired, overlooking the grape-size purple bruise smack dab in the center of my forehead. As one RealSelf reviewer wrote: “My head feels too tight, my eyebrow position has dropped enough to lose my nice pretty arch and my eyelids seem hooded. My eyes look smaller.” Now, if it works, looking a bit tired is a small price to pay for a few more days each month of migraine freedom and function. And bruises can be covered with makeup.
A recent encounter with one of my headache patients got me thinking. I am treating this young woman for chronic migraine with BOTOX injections. She told me that one of her other physicians had been surprised to hear about this use for onabotulinumtoxin A. According to my patient, the gastroenterologist’s words were, “BOTOX for migraines? I’ve never heard of that.” 
In response to the occurrence of these side effects, in 2008 the U.S. Food and Drug Administration notified the public of the potential dangers of the botulinum toxin as a therapeutic. Namely, they warned that the toxin can spread to areas distant from the site of injection and paralyze unintended muscle groups, especially when used for treating muscle spasticity in children treated for cerebral palsy.[28] In 2009, the FDA announced that boxed warnings would be added to available botulinum toxin products, warning of their ability to spread from the injection site.[29] Additionally, the FDA announced name changes to several botulinum toxin products, meant to emphasize that the products are not interchangeable and require different doses for proper use. Botox and Botox Cosmetic were renamed onabotulinumtoxinA, Myobloc was renamed rimabotulinumtoxinB, and Dysport name renamed abobotulinumtoxinA.[29] In conjunction with this, the FDA issued a communication to health care professionals reiterating the new drug names and the approved uses for each.[30] A similar warning was issued by Health Canada in 2009, warning that botulinum toxin products can spread to other parts of the body.[31]
Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis or neuromuscular junction disorders (e. g., myasthenia gravis or Lambert-Eaton syndrome) should be monitored when given botulinum toxin. Patients with neuromuscular disorders may be at increased risk of clinically significant effects including generalized muscle weakness, diplopia, ptosis, dysphonia, dysarthria, severe dysphagia and respiratory compromise from therapeutic doses of BOTOX [see Dysphagia And Breathing Difficulties].
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.
Baby Botox can be used pretty much anywhere on your face, but it's best to create subtle changes or to erase fine lines. "Something like this is especially nice for an area like the crow's feet, which is a very delicate area where a subtle treatment is more effective," explains Smith. "If someone has very deep folds, micro Botox probably isn't going to cut it. I would offer this to someone with moderate to fine lines."
Good question. botox can be used to help elevate the eyebrows, which contribute to the heavy lid look. You want the "depressor muscles" of the brow weakened leaving the "elevator muscles" still functional. It will give some lift. It may not be enough depending on the severity of the heaviness to your eyelids. A board certified plastic surgeons should be able to advise you... READ MORE

Botulinum toxin is used to treat a number of disorders characterized by overactive muscle movement, including post-stroke spasticity, post-spinal cord injury spasticity, spasms of the head and neck,[8] eyelid,[9] vagina,[10] limbs, jaw, and vocal cords.[11] Similarly, botulinum toxin is used to relax clenching of muscles, including those of the oesophagus,[12] jaw,[13] lower urinary tract and bladder,[14] or clenching of the anus which can exacerbate anal fissure.[15] It may also be used for improper eye alignment.[16] Botulinum toxin appears to be effective for refractory overactive bladder.[17]


After Hoffman’s husband was diagnosed with Parkinson’s at 55, his health insurance decided to stop paying for the drug he had taken successfully unless he tried cheaper alternatives. She appealed on behalf of her husband and was eventually able to get approval for the drug, which would have cost them $8,000 a year otherwise. “I felt terrible and I had to fight and it took a long time,” Hoffman tells The Verge. “It caused a lot of anxiety and a lot of these patients don’t have a law professor wife to fight for them.”
There are no studies or adequate data from postmarketing surveillance on the developmental risk associated with use of BOTOX in pregnant women. In animal studies, administration of BOTOX during pregnancy resulted in adverse effects on fetal growth (decreased fetal weight and skeletal ossification) at clinically relevant doses, which were associated with maternal toxicity [see Data)].
Selecting the correct injection points is critical to the success of the procedure. These points are first scored with a marking pencil. Your doctor will likely select numerous injection points for each location to be treated. (These points are located where the muscle contracts — not necessarily at the wrinkle you are hoping to erase.) The Botox filler is then injected into the marked points beneath the skin.

Serious and/or immediate hypersensitivity reactions have been reported. These reactions include anaphylaxis, serum sickness, urticaria, soft tissue edema, and dyspnea. If such a reaction occurs, further injection of BOTOX should be discontinued and appropriate medical therapy immediately instituted. One fatal case of anaphylaxis has been reported in which lidocaine was us ed as the diluent, and consequently the causal agent cannot be reliably determined.
The more areas that need treatment the higher the cost of treatment. The reason is also simple – the cost of Botox or Dysport that the doctor pays for the drugs is relatively expensive and therefore that cost is obviously passed along to the patient. A second factor that many patients are unaware of is that Botox and Dysport come in a powder form that must be mixed with sterile saline to reconstitute the vial. The amount of water that is mixed with the Botox or Dysport determines the concentration of the medicine. Some doctors and nurses dilute the powder too much so that the concentration of Botox or Dysport is weak. So if you go to a provider who advertises a cheap price for injections you should question whether or not you are receiving a very dilute injection.This dilute mixture typically does not produce the same effect as a more or not concentrated (more expensive) injection and does not last as long.
In a double-blind study of 123 adults with regular, chronic migraine, the adults receiving botulinum toxin type A experienced fewer migraine attacks each month. In addition, attacks they did experience were less intense, of shorter duration, and required less treatment than adults who did not receive Botox injections for migraine. These injections were also well-tolerated in adults experiencing migraine with and without aura.
Botox should definitely last longer than a few weeks, but how much longer varies. First time Botox users, for example, might experience Botox wearing off in less than 3 months. However, as facial muscles get conditioned to Botox, results should lengthen. Botox injections around the eyes can also last shorter than 3 months. Men, on the other hand, tend to need more Botox than women. Whatever the case, Botox results should generally last around 3 months, give or take a few days.
"For a senior leadership team that has presided over significant value destruction due in no small part to a series of poorly thought out transactions and unforced errors, entrusting the same leadership team with the task of driving value recovery via further M&A is hardly confidence inspiring in our view, to say nothing of the message it sends to shareholders regarding accountability (or more notably lack thereof)," Piper Jaffray analyst David Amsellem wrote in a note on Wednesday.
Keep in mind that the price is often reflective of experience and quality. Botox injections gone wrong can lead to a  "Botox face", a droopy eyelid, migraine headaches, and frozen facial expressions. Unskilled or inexperienced injectors may also cause excessive bruising and more asymmetric results. Experienced plastic surgeons and dermatologists who are good Botox injectors can be much more expensive than injectors with limited experience.
With this in mind, the average cost for treating forehead lines varies from approximately $200 to $600. Patients with fine lines or smaller facial muscles won’t require as many units of Botox to achieve a successful outcome, whereas patients with stronger facial muscles (such as pronounced corrugator muscles which cause deeper frown lines) could require more.
With abnormal joint movement and inactivity, muscles can shorten and contract. In the case of muscle spasticity, the joint and soft tissue can be normal, but with constant contraction of a muscle because of spasticity the muscle can shorten. When it can no longer stretch to allow full range of motion, a contracture can happen. Agents that lessen the spasticity of the involved muscles best prevent this type of contracture.
Dr. Engelman says preventative is legit. “Most certainly! I do micro-injections on patients who are just starting to show the finest expression lines in order to prevent them from ever making the wrinkle." NYC-based board-certified plastic surgeon Norman Rowe, MD, is also a fan. "While Botox has a fundamental use in treating wrinkles that are already formed, it has a role in the prophylactic, or prevention, of wrinkles. So, don't think that you don't need Botox because you don't have wrinkles. If you want to keep that smooth skin, start with Botox before they form."
Costs to consider: immediate out-of-pocket costs, long-term higher cost of insurance, your time, and the pain of injections. Botox for migraine costs approximately $525 per vial (100 units) and a typical migraine dose is 155 units. Depending on what your doctor charges in addition to the Botox itself, it’ll set you back $1500 – $2300 to test it out. And then there’s the needle pain. Don’t make the mistake of going to get a Botox injection if you’re in the midst of an attack, because it’ll be more painful than ever. Better to reschedule.
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. 

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.


Ratings on RealSelf.com (www.RealSelf.com) show a satisfaction rate of 65% for Botox, which is on par with other treatments such as Restylane, Juvederm, and Perlane and slightly higher than Xeomin and Dysport. Longer-term treatments, such as Ultherapy facial tightening and Liposuction/SmartLipo achieve ratings in the 80% and above area, while others such as CoolSculpting (Zeltiq) achieve ratings in the 70% area. This may reflect upon the short-term nature of all botulinum toxins versus the longer-term nature of these other procedures.
The most common side effect of the BOTOX procedure for migraines is neck pain. In clinical trials, 9 percent of patients reported this side effect. Other side effects can include headaches or muscle pain, but these side effects are far less common. If you do experience neck pain, an ice pack can help you manage the discomfort until it dissipates. At Allure Esthetic, we will perform the BOTOX for migraines procedure carefully and correctly.
A recent encounter with one of my headache patients got me thinking. I am treating this young woman for chronic migraine with BOTOX injections. She told me that one of her other physicians had been surprised to hear about this use for onabotulinumtoxin A. According to my patient, the gastroenterologist’s words were, “BOTOX for migraines? I’ve never heard of that.” 
Chronic migraines are what were formerly known as “transformed” migraines. These are near daily headaches, sometimes with migraine features but otherwise with frequent features of tension headaches. This may sound trivial but the treatment for tension headaches, typically with analgesics, would only make this syndrome worse. We learned that treating these with migraine preventive medications proved mostly effective. The current International Classification of Headache Disorders defines chronic migraine as a recurrent headache that has been ongoing for the past 3 months, occurs on at least 15 days per month, lasts at least 4 hours per day, and has 8 or more days per month when the headache has features of a migraine or responds to a typical migraine medication.

There is no cure for migraine currently. Don’t expect to walk into a doctor’s office, get a pill and feel better immediately. Having a variety of treatments can help you live a healthier life. Taking walks with my kids seems nearly impossible some days, and others it clears my mind and boosts my adrenaline. I receive both massage and acupuncture treatments for migraine pain and the general aches and pains that come with caring for and taking care of children. Mental health, as well as physical health, should be addressed. Time for rest and recovery needs to be a priority, to keep from overdoing it.
Is the cosmetic injectable product real? Great question! The answer is maybe? It is possible that the provider dispensing Botox or Dysport obtained the drug from an overseas dispensary outside of the United States. These foreign vendors sell Botox and Dysport to doctors and nurses in the U.S. at a discounted price but their product is not always the real thing. That’s right! The Botox maybe counterfeit. The bottles may look identical but the product inside may not be real which means it may not work as effectively or not at all ! So if the provider is offering Botox or Dysport really cheap The first question should be –Was it manufactured by the U.S. company?
Risks are very minor with this procedure. The main risks consist of headache, pain, and flu-like illness. In rare cases, there may be a drooping lid or eyebrow area. It is important for the cosmetic surgeon to assess the patient's lids before injecting because the patient may not be a good candidate if he or she has an extremely droopy lid to begin with or one that is held up by constantly arching the lids. Ptosis (a severe drooping of the eyelid) can occur in up to 5% of patients but is very rare if the cosmetic surgeon does this procedure often. These complications are typically very minor occurrences and resolve with time.
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.
Sunburn alert: The AHA/BHA Exfoliating Cleanser and AHA/BHA Cream in the Lytera® 2.0 Advanced Pigment Correcting System contain an alpha-hydroxy acid (AHA) that may increase the skin’s sensitivity to the sun and particularly the possibility of sunburn. Patients should use a sunscreen, wear protective clothing, and limit sun exposure while using these products (or this system) and for a week following.
Patients with diabetes mellitus treated with BOTOX® were more likely to develop urinary retention than nondiabetics. In clinical trials, 12.3% of patients (10/81) with diabetes developed urinary retention following treatment with BOTOX® 100 Units vs 0% of patients (0/69) treated with placebo. In patients without diabetes, 6.3% of patients (33/526) developed urinary retention following treatment with BOTOX® 100 Units vs 0.6% of patients (3/516) treated with placebo.
The migraines started later in life, before my lupus diagnosis. While sometimes they’d come out of the blue or I’d wake up with them, other times I’d see them coming. From a neurologist’s suggestion, I learned some of my “triggers” such as weather changes (specifically, drops in barometric pressure and incoming storms), hormonal changes and dairy. This past year I significantly reduced my dairy intake and although that didn’t eliminate the migraines, if I did eat dairy, I was sure to get one. Many of my migraines would also start as tension headaches. My neck is always extremely tight and eventually the constant tightness causes a migraine. Due to this, my old rheumatologist suggested taking a muscle relaxer at the beginning of a headache or before bed to keep my muscles from tensing up overnight and preventing a migraine. It worked sometimes… but definitely not enough.
Results can vary depending on who is performing the injection on the patient. It is very important to go to a physician who is experienced at this procedure, does it him- or herself (rather than having a nurse, physician's assistant [PA], or other nonphysician do it), and has a good reputation for performing this type of procedure. The manufacturers of Botox recommend physicians inject the medication themselves. As with most procedures, the skill of the practitioner is related to how often he or she performs the procedure.

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%.

It’s not just about Botox, though. Last month, the FDA approved the first migraine-specific drug to prevent the severe headaches. Called Aimovig, the injectable med will cost $6,900 a year, according to The New York Times, plus injection fees. Because of the high costs, experts expect the new drug to be subject to step therapy policies. Stephen Silberstein, the director of the headache center at Jefferson University, told me in 2016 that he wouldn’t be surprised if insurance companies required patients to even try and fail Botox before covering the new meds (there are a few of them under development).
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.

There is no cure for migraine currently. Don’t expect to walk into a doctor’s office, get a pill and feel better immediately. Having a variety of treatments can help you live a healthier life. Taking walks with my kids seems nearly impossible some days, and others it clears my mind and boosts my adrenaline. I receive both massage and acupuncture treatments for migraine pain and the general aches and pains that come with caring for and taking care of children. Mental health, as well as physical health, should be addressed. Time for rest and recovery needs to be a priority, to keep from overdoing it.

Are you ready to put your best face forward, but fear that Botox and other “lunchtime facelifts” are out of your budget? Are you wondering, “How much does Botox cost?” You may be pleasantly surprised to learn that some of the most popular and effective cosmetic treatments available are well within reach. A quick word of warning, though: If the prices seem too good to be true, they probably are. The products may be diluted or the treatment provider inexperienced. It’s worth spending a little extra time and money to get the results that you’re dreaming about!
Focal Spasticity is a condition in which certain muscles in your body become stiff or tight. It is caused by damage to parts of the central nervous system that control voluntary movements. When this happens, your nerves send continuous messages to your muscles telling them to contract, or tighten. If you or someone you care for has stiffness in the muscles of the elbow, wrist, fingers, thumb, ankle, or toes, it could be Focal Spasticity.1
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