Botox for headache

[drf]

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What are people doing? Units? Where?

In the clinic we have been using the PREEMPT protocol, 155-195 units 30-40 sites. 5 units per 0.1 ml NS or bupi 0.5%.

In the past I've also given Botox in the next for cervical or occipital headaches with some success.

Just curious

 

[epidural man]

2.5 units/ml -

Total dose 100 units

Works like a Huey Lewis new drug.

 

[PMR 4 MSK]

The Allergan rep keeps wanting me to do the PREMPT protocol, but I don't regularly see HA pts, just a few that have HA's in addition to whatever I see them for. So I've done a few b/w 100 and 200 units.

 

[lobelsteve]

I haven't bought into Botox for treating things other than spasticity.

Oh the horros of all those CP kids during residency. Squirming and screaming through the injections.

Not as bad for the CVA folks or SCI folks.

Not used it for headaches or myofascial pain. $1000 every 3 months with eh for results.

How much of the literature is bought by Allergan?

 

[epidural man]

I haven't bought into Botox for treating things other than spasticity.

Oh the horros of all those CP kids during residency. Squirming and screaming through the injections.

Not as bad for the CVA folks or SCI folks.

Not used it for headaches or myofascial pain. $1000 every 3 months with eh for results.

How much of the literature is bought by Allergan?

Agree with the "eh" for myofascial pain.

It works VERY well it most headaches - some of my patients had horrible debilitating headaches, that have been headache free since I started them on injections - and nothing else worked for them, or not to this extent.

The cost is problematic...

 

[specepic]

I haven't bought into Botox for treating things other than spasticity.

Oh the horros of all those CP kids during residency. Squirming and screaming through the injections.

Not as bad for the CVA folks or SCI folks.

Not used it for headaches or myofascial pain. $1000 every 3 months with eh for results.

How much of the literature is bought by Allergan?

Maybe if it was done with US you would be more enthusiastic?

 

[ghost dog]

I haven't bought into Botox for treating things other than spasticity.

Oh the horros of all those CP kids during residency. Squirming and screaming through the injections.

Not as bad for the CVA folks or SCI folks.

Not used it for headaches or myofascial pain. $1000 every 3 months with eh for results.

How much of the literature is bought by Allergan?

Even then, the evidence for headache is far from persuasive.

 

[painstop]

Even then, the evidence for headache is far from persuasive.

I love seeing the graphs comparing placebo to Botox for this injection...it does seem to make a difference but the placebo effect is striking...I'm sure many of you have noticed this with the Butrans patch and other things we utilize in clinic...mind over matter is key with these pain patients.

I'm trying to schedule a few chronic daily migraineurs next month for this...155 Units in about 30 spots is a lot of poking

 

[joshmir]

Consider viewing your migraine patients through a different lens:

there are studies that demonstrate patients who experience their headaches

-focused around/behind one eye

-have allodynia/hypersensitivity on the side of the body contralateral to the side with the headache

-and describe their headaches as imploding - perceived a painful assault on the outside of the head (e.g., “I have a crushing headache”), versus exploding (which does not respond to botulinum toxins), which are perceived as a painful buildup of pressure inside the head (e.g., “my head is exploding”)

google imploding exploding migraine for more info

I have heard that some people mix botulinum toxin A and B (ie, botox and myobloc); the question I have is if you have a nonresponder to one type of toxin, are there any studies showing that switching to another type or mixing is a good idea?

 

[nvrsumr]

What are people doing? Units? Where?

In the clinic we have been using the PREEMPT protocol, 155-195 units 30-40 sites. 5 units per 0.1 ml NS or bupi 0.5%.

In the past I've also given Botox in the next for cervical or occipital headaches with some success.

Just curious

Does anyone have the pdf with this study and protocol they could share? Im getting behind on my reading.

 

[drf]

In my dropbox

 

[bedrock]

In my dropbox

what's that?

Can you just attach that as a pdf to your next post? I'd like to read that study as well.

 

[drf]

what's that?

Can you just attach that as a pdf to your next post? I'd like to read that study as well.

On my iPad until Monday or so and can't upload.

Read the dropbox post and I'll give you access.

I'm goingnto add a large US library as well when I get home.