Leftover Botox for Chronic Migraine: Ask Your Doctor
The use of Botox injections for migraine prevention is commonly the subject of questions and discussion in the Migraine.com community. But did you know that there is a specific protocol doctors are required by the FDA to follow in performing the injections? And did you know this protocol requires use of a specific amount of the medication that leaves some of the medication left over?
The FDA has approved Botox injections for patients who have been diagnosed with chronic migraine, which is defined as 15 or more headache days (not just migraines) per month. There is a specific pattern doctors are to follow in injecting the medication into the patient's muscles at seven different positions around the head and neck.
The approved protocol directs physicians to use a total of 155 units of the medication. Since the medication comes in 100 unit vials, the doctor's staff will need to order two bottles for each patient's procedure. This leaves an opportunity for you as a patient to talk to your doctor about whether and how that remaining medication can be used. There are a couple of options.
Sometimes doctors are required by insurance companies to "waste" the remaining medication. This means they must write down that they disposed of the remaining medication and that it wasn't used or saved. If your insurance company requires this practice of wasting, there is no option for your doctor to use the remaining portion of the Botox in another part of your body.
However, if your insurance company does not require wasting and you experience problems in additional areas of your neck and/or shoulders, your doctor can do injections in these areas that some patients find incredibly beneficial. It is important to know that asking your doctor to inject more medication into the muscle areas that he or she has already injected is not recommended and does not provide additional benefits.
I recommend asking your doctor what will happen to the remainder of the medication used for your procedure and starting a discussion about the options for your situation. Some doctors may be surprised at first that you have any idea about the Botox protocol for chronic migraine, but if you approach him or her in a respectful way, most doctors will not hesitate to have this conversation with you and may already be planning to use the remaining medication anyway.
Can you tell when a migraine attack is coming?