Botox: Benefits vs Cost vs Other Treatments

We’ve talked more than once about the complexities of using Botox for the treatment of chronic migraine disease.  Whether or not Botox (onabotulinumtoxinA) will be helpful seems to depend on many factors – how experienced is the doctor?  Where is Botox being injected?  How often?  And, of course, even if everything else is equal, every patient is still very different.

(Also see Botox for Migraine – how does it actually work?)

Neurologist Dr. Stuart B. Black, member of the International Headache Society and founding member and director of the Dallas Headache Clinic, recently wrote about Botox.  His article reminds us how much things have changed and how far we have to go.

Here are some of the challenges that he mentions (with some addition thoughts of my own):

• The Cost:  One treatment alone is $1,300-$1,500 in the United States.  Worse, some doctors are charging significantly more than that.
• Complete Treatment:  Botox works best when it’s part of more comprehensive treatment for migraine, and not alone.  That means you should be seeing a doctor who not only knows the details of your medical history, but also has training in a range of migraine treatments.  If you go to a doctor who just knows Botox injection, you may not get the benefit you really need.
• Insurance:  I probably don’t need to explain this – many of you know how complicated it can be to get insurance coverage.  An insurance company makes general rules for what it will cover – not rules that will be best for you.  For example, take a look at Aetna’s policy.  On the one hand, you could point out (as Dr. Black does) that none of the other treatments you’re supposed to try first are actually approved [by the FDA] for migraine.  On the other hand, some would argue that there’s better evidence for a host of other treatments not even listed, and that there are many more you should try before spending so much on Botox.

Dr. Black also mentioned the changes that are being made in which injection sites should be used.  I would add that this is still a huge issue for Botox.  Although we continue to change how injections are done, based (hopefully) on the best evidence, we still know very little about how different types of migraine and different people may react to different injection sites.  The time and cost involved in such research is staggering.  But it leaves a lot of questions about how well Botox will work for you.

Read Dr. Black’s full article from Clinical Neurology:  Weighing Botox’s Migraine Benefits Against Costs