Are Botox Injections Painful?
A reader asks, “I’ve been hearing about Botox. Does insurance cover it? How often do you have to have the shots and how many are there? Is it painful?”
Most insurance companies cover Botox.
Botox is FDA approved for the preventive treatment of Chronic Migraine. Most insurance companies will now cover Botox, but only if you have been diagnosed with Chronic Migraine. That means, you experience at least 15 headache days every month and at least 8 of those days meet the criteria for a migraine attack. There is almost always a pre-authorization process required before you can start receiving treatment. It is during this process that the doctor will evaluate your medical history to determine if you meet the criteria for a diagnosis of Chronic Migraine. The process usually doesn’t take too long – maybe a week or two.
Botox is an expensive treatment.
If it wasn’t for insurance and Allergan’s Botox Savings Card, my out-of-pocket cost would be almost $4,000 every 3 months. Because it is so expensive, most insurance companies require extensive monitoring to prove that it is really working. That typically means that you will be asked to track your headache and migraine attack frequency and submit regular written reports as long as you are receiving treatment. It’s a small price to pay if the treatment works.
Did I mention insurance? Yeah, you’re gonna need it. Medicare will cover Botox under the conditions I’ve described. However, they will deny most of the charges, forcing your doctor to eat most of the cost. My Medicare Advantage plan excludes almost $3,500 of the $4,000 my doctor bills. That means he gets paid less than $500 for each round of injections. Over half of that ($273) is my responsibility. That’s where the Botox Savings Card helps out. It helps cover my portion of the bill.
Understanding the process
The injection protocol for Chronic Migraine is very specific, involving 31 subcutaneous injections in the face, scalp, and neck. When my doctor teaches medical students, he uses me as his example and explains that it’s like a recipe. Follow the directions to get good results.
Several of our contributors have shared their experience with Botox. Reading their stories might help you understand the process and decide if it is right for you.
What about the pain?
The injections themselves feel like I’m being pinched or stung -- similar to an acupuncture treatment. So, yes, it hurts just a little. Occasionally one or two of the injection sites will sting a bit more (usually the ones on the back of my head). I’ve been able to offset that feeling by pretreating all of the injection sites with ice right before treatment. I’ve never left the doctor’s office in pain after a round of injections though.
Some people report that Botox treatments trigger migraine attacks. I’ve had eight rounds of Botox and only experienced a migraine attack after one of them. Most of the time pretreating with ice or NSAIDs will prevent this from happening. If it becomes a problem, talk to your doctor about treatment strategies.
When will it start working?
Some people respond right away, seeing relief in just a few days. Some take 2-3 rounds before seeing improvement. If you don’t see improvement by that 2nd or 3rd round of injections, then Botox probably isn’t going to work for you. However, if it is effective, you can expect to see continued improvement maxing out after the 5th round and maintaining that level of protection for as long as you keep getting injections.
How long does it last?
Botox does wear off though, so you do have to keep getting injections to continue getting benefit. For most people, relief lasts 8-10 weeks. The down side is that you have to wait a full 12 weeks between treatments, so you can see an increase in frequency during the week or two just before your next appointment.
Can you tell when a migraine attack is coming?