10 Tips for Getting the Most from Botox
"Have you tried Botox?”
How many times has someone asked you that question? You’ve probably heard it more times than you can remember. It’s as though everyone thinks that Botox will cure migraine. Well, it doesn’t. It is an FDA approved treatment for the prevention of chronic migraine. For many people, it has been the only treatment to work.
When I asked my doctor about Botox, he encouraged me to give it a try. Even though I had talked to a lot of patients, there were still a lot of things I didn’t know, especially when it came to paying for the treatment.
What you need to know
#1 - Weigh the risks
Like all medical treatments, Botox has side effects. Most are mild and reversible. In rare cases, more serious side effects can happen. Don’t use Botox if you’ve ever had an allergic reaction to any botulinum toxin product. The most common side effects of Botox injections are a result of the toxin spreading away from the injection site. These can include loss of strength and muscle weakness all over the body, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing. Any one of these should be reported to your doctor.
#2 - Reality check
Botox is a highly successful preventive treatment for chronic migraine. That doesn’t mean it will work for everyone and it certainly won’t stop patients from ever getting another migraine attack. Not everyone will have the same experience.
#3- Adjust your expectations
When used as directed, Botox is FDA approved for the prevention of chronic migraine. So are a handful of medications. None of these treatments are effective for every patient. That’s why your doctor will ask you to track your attack frequency and provide written documentation at each appointment. This will allow the doctor to determine the effectiveness of each round of injections. Like any other preventive treatment, there’s no way to know how you will respond until you try it.
#4 - Find an experienced clinician
Experience matters. A well-trained doctor who administers Botox injections to several patients every week increases the odds of a positive outcome. An experienced doctor will also be familiar with side effects and how best to address them. Be willing to look around to find the best doctor, even if it’s not the one you usually see for migraine. You can search for qualified providers at the Botox for Chronic Migraine website.
#5 - Talk to your insurance company
Once you have a list of qualified doctors narrowed down to the 4-6 most experienced, check those names against your health insurance provider’s list of approved physicians. Make your first calls to the ones that accept your insurance. You may be tempted to accept the first available appointment, but trust your gut. Sometimes the best option is the one that requires more wait time. A doctor with a waiting list is often one worth waiting for. Pay attention to interactions with office staff and nurses. You will likely spend more time with them than with the doctor. If you are able, drive by the office location or drop in just to get a feel for the place. If you don’t get a good first impression, move on to the next name on your list.
#6 - Enroll in the Botox Savings Program
When you have decided on a doctor and scheduled an appointment, use your wait time wisely by enrolling in the Botox Savings Program. It is designed to assist with the out-of-pocket expenses that your insurance doesn’t cover. In some cases, between your insurance and the program, you may not owe anything for several appointments.
#7 - Broke? Uninsured?
Don’t let that stop you. Try the Botox Patient Assistance Program. Allergan has a Patient Assistance Program designed to provide Botox injections at no cost for qualifying patients. If you and your doctor decide that Botox is right for you, then it’s worth a try to see if you meet the criteria.
#8 - Preparing for your appointment
A lot of providers will take care of any insurance prior authorizations. However, it never hurts to double-check with your insurance company a day or two before your scheduled appointment. About an hour after my 4th round of injections, I received a phone call from my insurance company informing me they had denied coverage. It was a stressful few days before the situation was cleared up. Thanks to the hard work of a determined nurse, the denial was reversed and my injections were finally covered. The denial was based on one incorrectly answered question – a technicality that could have left me with an $8,000 bill. Trust me. Save yourself the stress and verify approval before you leave the house.
Make sure to take your photo ID, insurance card, and migraine diary to the appointment. You might think about taking along a disposable cold pack. Applying cold to the injection sites before the procedure will numb the skin and reduce the risk of a post-injection migraine attack. I never had this problem, but a lot of my friends say this is a common occurrence. You might also talk to your doctor about pre-medicating with NSAIDs or triptans.
#9 - What to expect
Botox injections are typically administered during a brief office visit. The nurse checks my vitals, asks for my headache diary, and then preps a tray with alcohol, cotton swabs, vials of Botox solution and syringes. The doctor wipes each area with alcohol, then injects a small amount of the solution under the skin. The protocol for chronic migraine involves 31 separate injections of 0.1 mL each in seven different muscles.
Some patients experience a lot of pain while others feel only a mild prick with each injection. Staying relaxed helps reduce the sensation of pain. Pretreating the injection sites with cold packs can help reduce the pain. I’ve had 5 rounds. One was more painful than all the others. The strongest pain has occurred with the occipital injections. I’d rate the discomfort at 1-3 compared to the 5-6 of a migraine attack or an 8-9 of a cluster headache attack. Overall, I’ll gladly accept the pain of injections in lieu of near-daily migraine attacks. The trade-off is definitely worth it.
#10 - After the appointment
There is nothing special you must do or avoid doing after a round of Botox injections. I have been able to go about my day as usual, without any activity restrictions. My last round occurred in the middle of packing up my house for our move. I returned home and continued to pack boxes for the rest of the day. However, if you are concerned about the procedure triggering a migraine attack, you may want to take it easy for the first day or two. Continue to apply ice to the injection sites to reduce the chance of swelling or irritation to the trigeminal nerve branches. With your doctor’s approval, you may want to use an OTC NSAID as a short-term preventive.
If you are enrolled in the Botox Savings Program, when you receive your bill or insurance EOB, take a few minutes to submit your claim. You can fill out the form and mail it in with a copy of your invoice. You can also submit your claim online. You will receive a letter in the mail when your card has been reloaded. Use the funds to pay for your portion of the procedure.
How quickly you start to feel relief can vary. Some patients don’t get any relief until the 2nd or 3rd round of injections. Some start to feel results within the first week. After my first round, the attacks subsided during the 2nd week and gradually occurred less often. In most cases, treatment reaches maximum benefit by the 4th or 5th round of injections. Long-term treatment is recommended for patients who respond positively. Like all preventive treatments, there is no guarantee it will work indefinitely.
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