About BOTOX

BOTOX for injection is indicated for the prophylaxis of headaches in adult patients with chronic migraine. BOTOX is a prescription medicine that is injected to prevent headaches in adults with Chronic Migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years or older. BOTOX therapy is the first and only preventive treatment approved by the FDA for adults with Chronic Migraine, and may help you have fewer headache days. BOTOX prevents up to 9 headache days a month (versus up to 7 days with placebo injection) at 24 weeks.

Getting Started

Acute treatments are taken when a migraine or headache is starting or has begun. Preventive treatments, on the other hand, are taken regularly to help stop migraines and/or headaches from occurring as frequently. BOTOX therapy is for adults with Chronic Migraine, 15 or more headache days a month, each lasting 4 hours or more. It is not known whether BOTOX is safe or effective to prevent headaches in patients with migraine who have 14 or fewer headaches days each month (episodic migraine), therefore BOTOX is not approved for adults who have 14 or fewer headache days a month. BOTOX prevents headache days associated with Chronic Migraine and because it's preventive, you will receive injections by your doctor on a regular basis (once every 12 weeks).

BOTOX at TOA

Which TOA providers treat with BOTOX?

For headache: Dina Eisinger, MD; Leonilde Alves, PA-C; Carl Smith, MD; Raphael Orenstein, MD; Eugenia Zimmerman, MD; Catherine Duncan, DO; Perico Arcedo, DO. For spasticity: Robert Wilson, MD

Which TOA locations offer BOTOX treatment?

Durham (William Penn Plaza), Oxford, and Wake Forest-Wakefield

Does insurance cover BOTOX?

Yes, insurance is accepted. If a patient's insurance does NOT cover BOTOX, we follow the Self-Pay Agreement policy (25% off procedure).

What to Expect During Treatment

31 injections are given over 7 areas of the head and neck. There is no daily treatment. Because BOTOX therapy is a preventive treatment, it is recommended that treatment be repeated once every 12 weeks. The injections take place at your doctor's office. The treatment session takes no longer than a regular doctor visit. The needles used are small, but you may feel some discomfort. Injections feel like tiny pinpricks

FAQ

What is BOTOX?

BOTOX is part of a group of drugs known as biologics. Biologic medicines are made from living things. BOTOX neurotoxin is a purified protein that is made from a type of bacteria called Clostridium botulinum type A.

What are the common side effects with BOTOX?

The most common type of side effect seen in Chronic Migraine clinical trials was neck pain, experienced by approximately 9% of people in the BOTOX group versus 3% in placebo group.

Does my insurance plan cover BOTOX?

Most plans, including Medicare and Medicaid, cover the cost of treatment. BOTOX for appropriate Chronic Migraine patients has 100% Medicare coverage and broad coverage in most commercial plans (93%).

How long until I start seeing results?

With 1 treatment injected by your doctor every 12 weeks, after 2 treatment sessions you may be able to start living with fewer headache days.

If I have a headache or migraine while I am on BOTOX, can I still take other medications?

Over-the-counter and prescription medications (acute) may still be taken during treatment. You and your doctor will discuss a treatment plan that's right for you.

Pain management:

Medical Management
Chronic Pain Management
• Expert evaluation and diagnosis
• Coordinated care
• Medical management
• Treatment planning
Electrodiagnostics (EMG/NCS)
Discogram

Common Conditions
• Joint Pain
Herniated disc
Sciatica
Spinal Stenosis
Chronic Low Back Pain
Chronic Neck Pain
Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy
Chronic Myofascial Pain
• Fibromyalgia
Failed Back Syndrome
Chronic Headache

Treatment Options
• Manual Medicine
Physical Therapy
Occupational (Hand) Therapy
Work Conditioning Programs
Cognitive/Behavioral Pain Management
Biofeedback
Hypnosis
Behavioral Therapy
• Spinal Injections
Epidural Steroid Injections

Common Non-Surgical Treatments:

Interventional Pain Management Procedures:

 

Epidural steroid injections are spine injections in the neck (cervical), mid back (thoracic spine), and low back (lumbar spine). These injections are done under x-ray guidance placing steroid (strong antiinflammatory) into the spinal canal to help with inflammation problems involving the discs and nerves of the spine. These injections can be done in the midline of the spine (interlaminar) or along side of the spine (transforaminal/selective nerve root block). These injections are mostly therapeutic (helps to treat your pain), but the selective nerve root block often times can have diagnostic use (helps to find the source of your pain).

Neck, mid back, and low back pain is often generated by the small joints of the spine (facets/zygo apophyseal joints). These can be successfully injected under x-ray guidance with steroid reducing joint inflammation and pain. These injections are quite helpful in alleviating localized neck, mid back, and low back pain. If the injection only helps temporarily, facet joint radiofrequency lesioning (RFL) is often considered.

Trigger point therapy is a temporary block of myofascial pain involving injection of local anesthetic and/or steroids. It is used in combination with therapy program to treat various muscle pain problems involving the spine and extremity. It is quite safe and can easily be performed in the office.

RFL is a procedure involving the selective blocking of pain in the neck and low back region coming from the facet joints. It involves placing a specialized needle on the small medial branch nerves that carry the pain input from the facet joints. This area is subsequently anesthetized and electricity through the needle heats the tip, burning and killing the small nerves providing pain relief 6-12 months or longer. This procedure can also be done for chronic sacroiliac joint pain.

Prolotherapy is an injection technique done to help strengthen weak tendons and ligaments. Injection is done in multiple areas stimulating new growth and strengthening the tendons and ligaments of the areas injected. It is used typically for chronic spine pain as well as chronic peripheral joint pain involving the shoulders, elbows, wrists, hips, knees, feet and ankles.

Sympathetic blocks are provided for specific nerve pain involving reflex sympathetic dystrophy/complex regional pain syndrome. These are unusual pain problems involving abnormal nerve response to injury with subsequent severe pain of the arms or legs. Sympathetic block can often times block this pain resetting the neurological system for more normal functioning and less chronic pain. Sympathetic nerve blocks are done in the neck (stellate ganglion block), and low back (lumbar sympathetic block). These are done with x-ray guidance very successfully alleviating pain from RSD/CRPS.

Spinal cord stimulator is an advanced treatment technique for refractory nerve pain involving the arm or legs with or without spine pain. A wire is implanted within the spinal canal providing stimulation on the nerves in order to block the pain input to the brain. It is often used for difficult chronic nerve pain as well as chronic back pain that has not responded to multiple surgeries. It has also been used quite successfully for pain and limitations from peripheral vascular disease.

Botox is an injection therapy into the muscle, which helps to temporarily relax the muscle. It is often used for treatment of chronic myofascial pain syndromes as well as spasticity and headache.

Percutaneous discectomy is a minimally invasive procedure in the lumbar spine for small disc herniations with radiculopathy/sciatica. It can successfully alleviate the pressure of the small disc upon the nerves without surgical intervention. It is safe and effective in the appropriate patient population.

IDET is used to treat primarily back pain coming from the disc due to torn ligaments of the disc. It is a minimally invasive procedure involved with placement of a coiled wire within the disc. This wire is then heated causing shrinkage and tightening of the disc ligaments, as well as reduction of painful nerve stimulus. This is a safe procedure for people with chronic back pain due to minimal degenerative disc disease.

A discogram is a diagnostic examination performed under x-ray guidance, in which dye is injected into the center of one or more injured discs. The doctor uses a fluoroscope (special x-ray screen) in order to see the dye in the disc(s) and assess the structural damage. During the procedure, the doctor can determine the degree of pain caused by the disc injury, as well as a diagnosis such as a ruptured, torn, or degenerated disc. Discograms are commonly performed prior to surgery in order to pinpoint the location and severity of the disc problem.

 

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