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Q: What is Botox®?
A: Botox ® is a small dose of Type A Botulinum Toxin that is injected to temporarily weaken the target muscles. Dr. Guyuron first introduced this treatment to plastic surgeons for the purpose of aesthetic facial improvement over 20 years ago.
Q: What are the chances that the injection for Botox® will help my migraine headaches?
A: Botox® has proven to be an extremely reliable prognosticator. Over 90% of the patients who respond favorably to the injection of Botox® benefit from migraine surgery. Studies have shown that 60-80% of the patients who have undergone injection with Botox®, with proper landmarks and techniques, experience elimination or significant improvement of their migraine headaches.
Q: What is the surgical procedure?
A: The surgical procedure can vary depending on the patients trigger site. With injection of Botox®, we can identify where the trigger site is and eliminate the offending stimulation. The trigger site can either be a muscle or a deviated septum. Generally, the operation will be done as an outpatient procedure under sedation or general anesthesia. The muscles that commonly cause migraine headaches include the frowning muscles in the forehead and a muscle or nerve branch in the temple area. A muscle in the back of the head may also cause migraine headaches. A small segment of muscle over the nerves is removed through small, hidden incisions. This procedure often results in improvement of forehead lines and eyebrow position.
A septoplasty, if indicated, is combined with another minor procedure called a partial turbinectomy. This typically results in an improvement in breathing along with elimination or improvement of the headaches.
Q: How does Botox® affect migraine headaches?
A: The hypothesis is that Botox® results in temporary weakening of the muscles that impinge on the nerves. These nerve branches have been pinpointed as some of the trigger areas that cause migraine headaches.
Q: How long does Botox ® last?
A: The effect of a Botox® injection may last from 3 to 5 months in the muscles. However, migraine headaches may disappear only for 1 to 3 months.
Q: Are there any side effects?
A: Side effects may include a more youthful appearing brow, and, in those requiring septoplasty and/or turbinectomy, oftentimes improved nasal breathing. Temporary numbness is almost always present, but generally resolves within two to six months. Generally, this numbness is not severe enough to cause complaints.
Q: What are the possible complications of Botox® injection or migraine surgery?
A: Any procedure involving incisions, regardless of the professionalism and skill of the performing surgeon, contains the possibility of complication. In addition to the general risks associated with incisions other complications, though rare, may include:
• Discomfort at the injection sites
• Mild bruising or swelling lasting a few days.
• Temporary droopy upper eyelids from Botox® testing
• Temporary hair loss (rare)
• Temporary (and rarely permanent) numbness in the forehead and scalp
• Infection and/or bleeding
• Nasal whistling, crusting, occasional bleeding, numbness of the upper teeth
(if septoplasty is done)
• Dryness inside the nose, if turbinectomy is done
• Change in brow appearance and movement
• No change in symptoms
• Worsening of symptoms
Q: What are the financial implications of this procedure?
A: While we cannot comment on or guarantee your own individual experience following the procedure, it has been shown that migraine surgery patients experience, on average, a health care savings of over $6,000 a year.
Q: Will my insurance cover Botox®?
A: While we cannot comment on or guarantee your own individual experience following the procedure, it has been shown that migraine surgery patients experience, on average, a health care savings of over $6,000 a year.
Consider this excerpt from http://www.myplasticsurgeonusa.com/scott-mosser/san-francisco-plastic-surgery-news.htm?art=344 an article written by Dr. Scott Mosser, MD,a San Francisco-based plastic surgeon who also trained with Dr. Guyuron. Dr. Mosser also attended as an expert presenter at the first Migraine Surgery Symposium in Cleveland, Ohio:
“After the use of Botox® for migraine therapy was initiated in 2001, protocols for Surgery for Migraine Headaches were developed by Dr. B. Guyuron, with whom I trained extensively. During my training, I had the opportunity to participate in groundbreaking research, which is now leading to pain relief for migraine sufferers around the nation.
I’m excited by the results we’ve achieved. In one study it was demonstrated that after surgery performed by a surgeon trained specifically in these particular techniques, 92% of the patients (82 of the 89 participants) in the treatment group who completed the study demonstrated at least a 50% reduction in migraine headache frequency, duration, or intensity compared with the baseline data. A full 35% (31 of the participants) reported complete elimination of migraine headaches, and 57% (51 patients) experienced improvement over a mean follow-up period of 396 days.
A comparison of the costs of migraine headache control therapy was also recorded in the above study. The mean annualized cost of migraine care for the treatment group ($925) was reduced significantly compared with the baseline expense ($7612) and the control group ($5530). The mean monthly number of days lost from work for the treatment group (1.2) was reduced significantly compared with the baseline data (4.41) and the control group (4.4).“
Q: Will my insurance cover Botox ® injections or the surgical procedure?
A: At this time most insurance companies will cover Botox testing or treatment, provided that conventional medical treatments, such as abortive and preventative medications, have been tried. Some insurance companies have specific requirements that must be met prior to Botox approval. Regarding the surgery, we are finding a ever-increasing coverage of the surgery by many, if not most, insurance companies. This may be a time-consuming process, and may require a way for the appeals process, though success is more the rule than the exception, thankfully. We have found that vigilance on the part of the patient, with phone calls, letters, and copied medical records, is the key to obtaining approval from your carrier.