Botox for Migraine
CDH offers Botulinum toxin treatment for prevention of chronic migraine. We use the protocol approved by the FDA. There is reasonable evidence that this protocol is helpful, although the strength of the effect reported in the literature is not high. We think that it is best suited to patients who have failed all other treatments.
As of 6/2014, we have treated 47 patients. 82% of our patients have had a positive response, and 85% of 157 injections have brought benefit. Our experience so far has been that 63% of patients who have failed every other treatment, respond to Botox. The average age of our patients is 50, and most have been perimenopausal women.
This response is much better than is generally reported. It may be that due to the high prevalence of migraine around menopause, our results are especially good due to selection bias (i.e. our patients really do have migraine, not another cause of chronic headache).
Botox treatment is expensive due to the high cost of botulinum toxin (sold by Allergan). The cost of drug alone for a standard treatment is about $1000. Then there is also the cost of doctor's time, office overhead etc.
Some insurances cover Botox for chronic migraine, and we will atempt to "precertify" persons in this situation. It is very important to keep good records of headaches.
Medicare does not fully cover the standard Botox protocol for migraine, as there are two locations for injection (basically front and back).