Botox for Migraine:
Indication:
- Chronic migraine (> 15 days of headache per month)
Technique:
- 31 sites are injected with 5 unites each. Total dose of 155 units each session.
- Injections should be done at least 12 weeks after the prior injection to avoid antibody formation.
- Preparation:
- While the patient is setting in a chair, examine the patient to identify the landmarks (listed below).
- Withdraw 2 ml of normal saline and smoothly inject it into the Botox vial.
- Using a 1.5" 25G needle, withdraw the reconstituted Botox into a 1ml syringe then switch the needle to 30G 0.5". This way, each 10 units of the syringe (0.1ml) will contain 5 units of Botox.
- Adjust the needle so the bevel faces the same direction as the syringe marks.
- Injection:
- Make sure the bevel is facing up, aspirate before injection, try to inject in the superficial layer of the muscle (once you feel the loss of resistance, when needle cross the dermis).
