Botulinum toxin treatment of migraine

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By Andrew Blumenfeld MD

One of the most intriguing developments in the management of headaches is the use of botulinum toxin. In this clinical article, Dr. Andrew Blumenfeld, former Chief of Neurology at the Kaiser Permanente Medical Center and current Director of The Headache Center of Southern California in San Diego, California, explains the basics and provides a practical guide to preventing migraine with botulinum toxin, including patient selection, injection site considerations, dosing, and technique. He describes the injection protocols and offers tips based on his personal experience and published caveats. Recent double-blind, placebo-controlled studies have been published on the effects of onabotulinumtoxinA on chronic migraine, and these data are included in this article.