Botox was demonstrated to be effective at reducing the frequency, severity, and duration of migraine symptoms in clinical trials. It has been an approved migraine treatment by Health Canada since 2011. In chronic migraine, we know now that sensory nerves become inflamed and hypersensitive due to several different neurotransmitters. Small amounts of Botox are injected in specific areas around these nerves to help blocks the release and effects of these neurotransmitters, and calms down the pain and sensitization involved in migraine. Botox does not simply "mask or numb" the pain. It actually works to reduce the abnormal nerve sensitization involved in migraine. In terms of outcomes, we look for an improvement of more than 50% in the frequency and intensity of migraines. In studies nearly 50% of patients receiving Botox for migraine achieved this goal after 2 sets of injections. Some people improve more than others (responders). 23% of patients in the studies improved by 75% (super responders). If you start at 20 days, you would go down to 5. The number of headache days is not the only outcome we're looking for. We're looking for improved tolerance to triggers, improved quality of life and ability to function, improved response to acute medication and overall less need to treat migraine attacks.

Botox for Migraine: Almost all private insurance companies will cover the cost of Botox to treat chronic migraine, however, they typically have a "Botox prior authorization form" that needs to be completed. Often times, insurance companies will want individuals to have tried two different oral medications used for migraine prevention. We offer complimentary information sessions to help you understand and navigate this process. The cost of the procedure itself (excluding the Botox medication) is $300 and is tax exempt. This fee is never covered by OHIP so is charged to all people in Ontario receiving Botox for chronic migraine whether it is a neurologist or a nurse practitioner. This fee is tax exempt and you will receive a receipt to claim as a medical expense. We cannot guarantee this cost is covered by private insurance. Botox for TMJ dysfunction: There have been some studies that show Botox treatment of the masseter can reduce pain and muscle spasm associated with clenching and grinding. However, this treatment is considered "off-label" meaning that Health Canada has not listed TMJ dysfunction as a recognized use for Botox. As a result, insurance companies will not cover the cost of this treatment. The typical cost is approximately $400 to 600 (tax exempt). These treatments should only be done as needed to avoid overtreating or weakening the masseter (jaw muscle). Often, patients find that having manual therapy on their jaw after Botox can help them sustain the benefits of the injection treatments.

Botox for Chronic Migraine: In short, it can take up to 3 treatments to see full effect from the Botox for chronic migraine. The treatments are scheduled 12 weeks apart and it is important not to go beyond that time interval otherwise you won't have the cumulative improvement that comes with each treatment. Half of people have a 50% improvement in severity, frequency, and/or duration of migraine symptoms after 2 treatments. We also look for improvements in quality of life and reduced threshold for attacks being triggered. Once you have gained good control over your migraine we want to continue treatment for a period beyond this before we stop to ensure that you don't revert back to chronic migraine. Some people make a choice to continue with Botox if it's working well for them and this is a safe option. We will discuss options for ongoing migraine treatment that best suit your needs at every visit. Botox for TMJ Dysfunction: Most people feel some benefit in muscle relaxation and decreased jaw pain after a single treatment. Botox for TMJ dysfunction does fix for misalignment or correct clenching/grinding behaviours. If large doses of Botox are used regularly for prolonged periods it can cause too much weakening of the masseter muscle. It is important to pair this treatment with manual therapy by a provider who understands TMJ dysfunction so that Botox is used as a treatment infrequently and at smaller doses. This can be discussed further through a complimentary information session.

Many people are surprised to learn that Botox is more commonly used for medical treatments than the cosmetic uses commonly shown in media. It has been approved specifically for migraine treatment by Health Canada since 2011 with no new safety concerns or findings since that time. Botox has a long history of medical use since the 1970s and a very good safety profile. It only acts locally around the injection sights so it a very safe choice for patients who have other medical conditions, are on medications, or for those who want to avoid side effects that are common with the older oral migraine preventive medications.

You have a few avenues for treatment and headache care: "Initial Headache or Migraine Consultation" is the best option if you are unsure what treatment is best for you and want a more comprehensive treatment plan. These are booked online, without a referral and can be in-person or virtual. "Botox for Chronic Migraine" or "Botox for TMJ/jaw pain" can be scheduled if you have previously had Botox treatment, have insurance coverage established, or are considering paying out of pocket for the treatment. Our staff will reach out to you before your visit to obtain additional health information You can schedule a "15-min complimentary information session" if you have more questions specifically about Botox treatment.