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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 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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Botox Prescribing Information. Last updated August 2011. Available at:


  • stacysillen
    6 years ago

    Dysport doesn’t leave much eft over, but Botox does. I already get it on the tops of my shoulders and lots in my forehead, but I do have two fused vertebrae in my neck that hurt often. I wonder how she could help me with that-I know she told me once that if she does it wrong I could have trouble holding up my neck for months. Also, I wish there was a way we could donate the leftover to someone who can’t afford it right now! I’d like that!!

  • Cindi
    6 years ago

    Thanks Diana! I will ask at my next appointment, which will be my second round of treatment.

  • jbinsley77
    6 years ago

    I have been receiving my Botox treatments for almost 2 yrs now. Since the very beginning my Dr has been injecting in my neck, and shortly there after injecting in the curve between my neck and shoulder. This helps my migraines so much more than just the standard injections in my head. I have always gotten my first indication of migraine in my neck and back of my head so this is a wonderful thing for me.

  • lindabriere
    6 years ago

    Where exactly are the 7 sites that are involved in the protocol? I get the shots but find the most help from shots around the Occipital bone so other points may help more to then the forehead shots. thank you

  • DebbyJ56
    6 years ago

    I am lucky enough to get injections in my head, neck and shoulders. Since I also have fibromyalgia, this is very beneficial to me. It really helps my pain.

  • Jennifer
    6 years ago

    Along with your injections you mentioned you have fibromyagia…I am wondering if you have any recovery time after the injections? My doctor stated that this could be an option for me but concerned, one will it even worked and two the recovery of the pain from the injections due to the fibromyagia.

    Thank you

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