Galli’s winning film presents herself, and people with migraine, as superheroes, living with a secret identity: migraine. “Other than me laying down on my couch, and knowing what's going on inside my body, nobody sees what's happening,” she says. “It's all happening inside. It's like that same struggle that superheroes have.” The migraine symptoms are superpowers, albeit ones that you don’t want. When her migraine attacks first began, Galli recalls an increased sensitivity to sound, odors, light and “all these things that feel not normal.” Many people with migraine are fighting the disease on their own, because their peers can’t relate to what their feeling on a daily basis. “It's time that we create better awareness and we tell the world that no, we don't need to be alone,” she says. “We don't need to fight alone and hide in the dark.” The film, she hopes, will add to the conversation and bring this disease out of the shadows. For the more than 37 million Americans living with migraine, Galli says: “You’re all superheroes. I hear you, I feel you.”

I increase the dose at each treatment cycle to 195 units. This is based on experience with patients with cervical dystonia, in whom higher doses result in a longer duration of effect. In addition, I transition to the next onabotulinumtoxinA treatment at 12 weeks by using occipital and trigeminal nerve blocks at 10 weeks. Most insurance companies will not cover onabotulinumtoxinA treatments earlier than 12 weeks, but in rare cases, 10-week cycles have been approved.
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.
Treatment with BOTOX and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with preexisting swallowing or breathing difficulties may be more susceptible to these complications. In most cases, this is a conseq uence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing [see Spread Of Toxin Effect].
In cosmetic applications, botulinum toxin is considered safe and effective for reduction of facial wrinkles, especially in the uppermost third of the face.[23] Injection of botulinum toxin into the muscles under facial wrinkles causes relaxation of those muscles, resulting in the smoothing of the overlying skin.[23] Smoothing of wrinkles is usually visible three days after treatment and is maximally visible two weeks following injection.[23] The treated muscles gradually regain function, and generally return to their former appearance three to four months after treatment.[23] Muscles can be treated repeatedly to maintain the smoothed appearance.[23]
When I wean patients off of treatment, I do not change the dose but rather delay the treatment cycle to 16 weeks and monitor headaches in the last 4 weeks. If the patient remains well-controlled, I increase the treatment window to 20 weeks, and so on. I use this method to establish the level at which patients need reinjection to prevent breakthrough headaches.11-13
Wrinkles, whether they be fine line or deep furrows, typically appear on areas of the body that receive a high amount of exposure to the sun. Smoking, light skin type, hairstyle, the way you dress, your occupational and recreational habits, and heredity are all factors that promote wrinkling. Medical treatments for wrinkles include antioxidants, moisturizers, alpha-hydroxy acids, and vitamin A acid. Cosmetic procedures that treat wrinkles include dermabrasion, microdermabrasion, glycolic acid peels, laser resurfacing, Botox, and fillers.
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?
“Botox is a completely cosmetic procedure, so if and when someone ‘needs’ it is a purely personal decision,” Shah says. “Some people are not bothered by developing fine lines and wrinkles. For those who are, I generally advise starting treatments just when they start to see the lines develop, or when the wrinkles linger even after the movement has stopped.”

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.
Botox can be bought by essentially any person with a DEA certificate. Allergan sells it in 50 and 100 unit vials. They are shipped overnight delivery on dry ice to keep the toxin effective it should be opened, reconstituted and used the same day ideally. The Botox will work best this way. Price points will change by who the injector is and what their motives are. Botox can be reconstituted so that you getting a very dilute amount of product. So a by the area approach may really only give you a small amount of product. Or you could be getting old Botox that is a week old and will not last for very long.
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).
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.
AromatherapyAccessories,Aromatherapy Sets,Diffusers...899 Bath & BodyAccessories,Aromatherapy,Bath Soaks & Bu...3297 CosmeticsBags & Cases,Body,Brushes & Applicators...9039 FragranceFragrance Gift Sets & Coffrets,Kids Frag...15774 Hair CareHair & Scalp Treatment,Hair Accessories...6211 Health CareCompression,Daily Living Aids,First Aid...5439 MassageAcupuncture & Acupressure,Foot & Leg Mas...2136 Men's Health & BeautyMen's Bath & Body,Men's Hair Care,Men's...4159
Women's AccessoriesWomen's Wallets,Women's Umbrellas,Women'...8528 Women's ClothingWomen's Swimwear,Skirts,Leggings,Women's...40956 Plus Size ClothingPlus Size Intimates,Plus Size Bottoms,Pl...1615 Maternity ClothingMaternity Dresses,Maternity Intimates,Ma...391 IntimatesPanties,Shapewear,Lounge & Sleepwear,Lin...3831 Women's ShoesWomen's Flats,Women's Evening Shoes,Wome...2798
Another factor to consider, more high volume practices have more patient incentives from Allergan and the other manufacturers. My patient's receive rebates from the company, instant savings at the checkout, and regular reminders about upcoming treatments and specials that are sponsored by Allergan. This program is only available to the nation's busiest, most successful practices.
The median duration of response in study NDO-1 and NDO-2, based on patient qualification for re-treatment was 295-337 days (4248 weeks) for the 200 Units dose group compared to 96-127 days (13-18 weeks) for placebo. Re-treatment was based on loss of effect on incontinence episode frequency (50% of effect in Study NDO-1; 70% of effect in Study NDO-2).
FurnitureBaby & Kid's Furniture,Bedroom Furniture...10110 Home DecorHome Accents,Lamps & Lighting,Rugs,Slip...13762 Storage & OrganizationEntryway Racks,Garage Storage,Trash & Re...5442 Office & School SuppliesPrinter Ink & Toner,Desk Accessories,Sca...12152 BathBathroom Scales,Bath Storage & Caddies,B...3908 Home AppliancesSmall Appliances,Irons & Garment Care,Se...3932 Heating, Cooling & Air QualityHeaters,Humidifiers,Fans,Dehumidifiers,A...1366 Mattresses & AccessoriesMattress Toppers & Pads,Mattresses484
A placebo-controlled, double-blind post-approval 52 week study with BOTOX 100 Units (Study NDO-3) was conducted in non-catheterizing MS patients with urinary incontinence due to detrusor overactivity associated with a neurologic condition. Catheterization for urinary retention was initiated in 15.2% (10/66) of patients following treatment with BOTOX 100 Units versus 2.6% (2/78) on placebo at any time during the complete treatment cycle. The median duration of post-injection catheterization for those who developed urinary retention was 64 days for BOTOX 100 Units and 2 days for placebo.
If you are seeking a Botox specialist, I have more than thirty years experience injecting Botox in New York City and New Jersey. I am a recognized oculoplastic surgeon – you can find me on Google as Dr. Joel E. Kopelman. I have authored several peer reviewed articles regarding the efficacy and safety of Botox injections. You can easily make an appointment to see me in consultation at our office +1 (212) 831-8333 to set up a consultation with me in either New York or New Jersey.
Each patient has their own goals for treatment of muscle spasticity made in our clinic. These goals can include decreasing pain from muscle spasms. This can be done by reducing both how often and how intense the spasms are. It can also be done by increasing the range of motion of joints to allow improved function. Improvement of range of motion can help to:
Last time I went in for my Botox treatment, my doctor asked me if I wanted to try Aimovig. Amgen and Novartis, the two manufacturers, were offering two free injections before I could access the drug through my health insurance. I declined. I didn’t want to start a new treatment that I’ll likely be booted from in a few months because of how expensive it is. Plus, the Botox is working great. I just wish I could have gotten it when I first went to see a migraine specialist, two and half years ago.

BOTOX® is the brand name of a toxin produced by the bacterium Clostridium botulinum. In large amounts, this toxin can cause a form of muscle paralysis known as botulism, which is usually associated with food poisoning. Even though one of the most serious complications of botulism is paralysis, scientists have discovered a way to use it to human advantage. Small, diluted (weakened) amounts can be directly injected into specific muscles, causing controlled relaxation of the muscles.
When receiving Botox, it’s critical to know what you’re getting and to be sure that you get what you pay for. Usually, the cost of Botox is calculated on a per unit basis. This is the preferred option of many patients and surgeons as you only pay for the units of Botox used to treat any given area. This means that if you only require ten units to correct your forehead wrinkles, you simply pay for ten units at the specified price and that’s it.
BTX-A is now a common treatment for muscles affected by the upper motor neuron syndrome (UMNS), such as cerebral palsy, for muscles with an impaired ability to effectively lengthen. Muscles affected by UMNS frequently are limited by weakness, loss of reciprocal inhibition, decreased movement control and hypertonicity (including spasticity). In January 2014, Botulinum toxin was approved by UK's Medicines and Healthcare Products Regulatory Agency (MHRA) for the treatment of ankle disability due to lower limb spasticity associated with stroke in adults.[19] Joint motion may be restricted by severe muscle imbalance related to the syndrome, when some muscles are markedly hypertonic, and lack effective active lengthening. Injecting an overactive muscle to decrease its level of contraction can allow improved reciprocal motion, so improved ability to move and exercise.
Dr. Starling says the FDA approval indicates that the anti-CGRP treatments are ideal for individuals with episodic migraine who have four to 14 headache days per month, and people with chronic migraine who have 15 or more headache days per month. Clinical trials are also being conducted to see if anti-CGRP antibodies are effective for the treatment of cluster headache. “The initial studies have demonstrated that it’s likely effective for cluster headache patients,” Dr. Starling says. The FDA’s approval of these medications has been incredibly meaningful for the migraine community. “The migraine community is feeling like they’re relevant—that they’re being seen, heard and taken seriously,” Dr. Starling says. “There are many people who are working hard to develop more treatment options until we can address every patient who has migraine, and eventually find a cure.”
When the deal with Teva closed in August 2016, it left Allergan with $40 billion to spend. Some of that went to repurchase shares, while some went to a series of acquisitions that totaled about $6.5 billion. One of the bigger deals was for a company developing treatments for NASH, a liver condition that Saunders said would become "one of the next epidemic-level chronic diseases we face as a society."

In some cases known as off-label use, doctors are safely administering it for conditions other than what it is officially approved for, including prostate issues, and eye-crossing (known medically as strabismus) cerebral palsy—which had my jaw on the floor. Rowe even went on to tell me it's the drug of the twenty-first century. "It's like Tylenol or aspirin," he marveled to SELF. "It's what penicillin was in the mid-twentieth century."
Treatment with BOTOX and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with preexisting swallowing or breathing difficulties may be more susceptible to these complications. In most cases, this is a conseq uence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing [see Spread Of Toxin Effect].

Just like any medical procedure the Botox treatment rarely comes with a few possible side-effects that are temporary. The frequency of complications generally decreases the more knowledge of facial anatomy that your injector possesses and the greater the experience of knowing where and how much to inject.That is not to say that complications can occur in anyones hands but the incidence decreases with greater experience.Allergic reactions to Botox or Dysport is exceedingly rare in my experience.
A concern of both parents and children is whether these injections will be painful. There is no pain linked to the action of the toxin itself, only with the needle injections. To lessen this problem, the skin where the injections will be done is coated with EMLA cream before the procedure . A topical coolant spray is also used right before the needle is put in. This numbs the skin. The child may still feel pressure from the needle and a dull feeling in the muscle. The fact that a child is having a procedure done and is being held in place can upset a child more than the needle going in, even more so for preschool-aged children.

University-based ophthalmologists in the USA and Canada further refined the use of botulinum toxin as a therapeutic agent. By 1985, a scientific protocol of injection sites and dosage had been empirically determined for treatment of blepharospasm and strabismus.[76] Side effects in treatment of this condition were deemed to be rare, mild and treatable.[77] The beneficial effects of the injection lasted only 4–6 months. Thus, blepharospasm patients required re-injection two or three times a year.

Our advice: if you’re going to try it, don’t give up on Botox for Migraine after the first try, and reconsider whether you’re a good candidate after three tries. Both Drs. Jackson and Kornel noted that there was a large placebo effect seen in many of the studies. “It’s hard to know if most of the benefit was from the drug or from the placebo effect,” said Jackson, who added, “but, patients don’t care if it’s a placebo effect.”

Marrying ophthalmology to dermatology, Jean and Alistair Carruthers observed that blepharospasm patients who received injections around the eyes and upper face also enjoyed diminished facial glabellar lines (“frown lines” between the eyebrows), thereby initiating the highly-popular cosmetic use of the toxin.[52] Brin, and a group at Columbia University under Monte Keen made similar reports.[53] In 2002, following clinical trials, the FDA approved Botox Cosmetic, botulinum A toxin to temporarily improve the appearance of moderate-to-severe glabellar lines.[54] The FDA approved a fully in vitro assay for use in the stability and potency testing of Botox in response to increasing public concern that LD50 testing was required for each batch sold in the market.[55][56]

It was peculiar advice coming from a shrink, but not without precedent. In 2014, Rosenthal, a clinical professor of psychiatry at Georgetown University School of Medicine, and Dr. Eric Finzi, an assistant professor of psychiatry at George Washington School of Medicine, published a study showing that when people with major depression got Botox, they reported fewer symptoms six weeks later than people who had been given placebo injections. "I'm always on the lookout for things that are unusual and interesting for depression," says Rosenthal, who is widely considered an expert on the condition. "I've found Botox to be helpful, but it's still not mainstream."


In the event of overdose, antitoxin raised against botulinum toxin is available from the Centers for Disease Control and Preventio n (CDC) in Atlanta, GA. However, the antitoxin will not reverse any botulinum toxin-induced effects already apparent by the time of antitoxin administration. In the event of suspected or actual cases of botulinum toxin poisoning, please contact your local o r state Health Department to process a request for antitoxin through the CDC. If you do not receive a response within 30 minutes, please contact the CDC directly at 1-770-488-7100. More information can be obtained at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5232a8.htm.
García Leiva specified that this treatment "is not a first-choice treatment for migraine sufferers, but it can only be applied in patients with chronic migraine who have tried several treatments with poor results, and who show peripheral sensitization of muscles. Recently, the Foods and Drugs Administration (USA) has approved botulinum toxin as a therapeutical drug for the treatment of chronic migraine.
If you find that your Botox wears off really fast, speak to the person who gave you the injections to find out why (i.e. if the Botox was too diluted, not enough was injected, the Botox was old, your anatomy requires a different technique, you might be resistant to Botox, etc). A reputable doctor will work with you to figure out how to make the Botox treatments worth your time and money. Keep in mind that for some people, Botox takes time to kick in - approximately 1-2 days to be noticeable and 1-2 weeks to peak.
"I had 25 units of Botox done by Dr. Goldberg on my forehead and frown lines. Few days later I could see the result with which I was very happy! [...] I have done Botox few times before with other specialists, after which my face would resemble a doll [...] However, after procedure with Dr. Goldberg, I am still able to lift my eyebrows and frown without forming any wrinkles." – from Dinara D.'s review of Alexander Golberg Physician PC in New York.

The trapezius muscle is a large, triangular, superficial muscle. It attaches proximally in the medial third of the superior nuchal line, external occipital protuberance, nuchal ligament, and spinous processes of the C7-T12 vertebrae. Distal attachment of the trapezius occurs at the lateral third of the clavicle and acromion and spine of the scapula. The action of the muscle includes neck extension and stabilization of the scapula and support for the arm. The muscle fibers proximal to the inflection point of the neck (ie, necklace line) run vertically and are involved with neck extension. According to the PREEMPT injection paradigm, one injection of 5 units of onabotulinumtoxinA to each of three sites on either side of the trapezius, for a total of 30 units divided across six sites, is given. The first injection site can be identified by visually dividing the upper portion of the trapezius muscle in half, from the inflection point of the neck (ie the necklace line) to the acromion (acromio-clavicular joint); the midpoint of this location is where the injection should be administered. The second injection is located at the midpoint of the first injection site and the acromion. The third injection should be administered at the midpoint between the first injection site and the necklace line. Injections should occur in the supraclavicular portion of the muscle, lateral to the neckline, and medial to the deltoid and the acromio-clavicular joint. The injections into the trapezius should be administered horizontally and superficially to avoid injecting too deep.


Patients should shave underarms and abstain from use of over-the-counter deodorants or antiperspirants for 24 hours prior to the test. Patient should be resting comfortably without exercise, hot drinks for approximately 30 minutes prior to the test. Dry the underarm area and then immediately paint it with iodine solution. Allow the area to dry, then lightly sprinkle the area with starch powder. Gently blow off any excess starch powder. The hyperhidrotic area will develop a deep blue-black color over approximately 10 minutes.
In 1986, Scott's micromanufacturer and distributor of Botox was no longer able to supply the drug because of an inability to obtain product liability insurance. Patients became desperate, as supplies of Botox were gradually consumed, forcing him to abandon patients who would have been due for their next injection. For a period of four months, American blepharospasm patients had to arrange to have their injections performed by participating doctors at Canadian eye centers until the liability issues could be resolved.[48]
In May, hedge fund Appaloosa Management, run by David Tepper, received antitrust clearance from the Federal Trade Commission to potentially increase its stake in the Botox-maker. This means that Appaloosa now has more flexibility to push for further changes at Allergan. It remains to be seen if that happens, but if so, it could mean more changes are ahead for the drugmaker.
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.
There are no data on the presence of BOTOX in human or animal milk, the effects on the breastfed child, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for BOTOX and any potential adverse effects on the breastfed infant from BOTOX or from the underlying maternal conditions.
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]
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.
Dermal fillers, as we’ve discussed in our previous post, vary on what you’re looking for and how long you’d like to see those results. According to the Plastic Surgeons Portal, the minimum you’ll pay for dermal fillers, like Juvederm and Restylane, is going to $1500, while the maximum you’re looking at is $2,500. It’s a small price to pay for radiance and confidence!
Tell your doctor about all your medical conditions, including: plans to have surgery; had surgery on your face; have trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® Cosmetic can harm your unborn baby); are breast-feeding or plan to (it is not known if BOTOX® Cosmetic passes into breast milk).
×