Headache & Migraine Treatment
New York City residents who suffer from chronic headaches or migraines can seek treatment with Dr. Johar at the New York City Pain Specialists practice in the Upper East Side. He provides a variety of treatments to relieve pain.
Botox for Migraines: There is a medical necessity for Botox for migrainous headaches when a patient has over 15 headache days per month with each episode lasting over 12 hours with severe pain. This affects the patients activities of daily living affecting more than 5 days missed from work and volunteer activities. Botox is indicated for prophylaxis of headaches in adult patients with chronic migraines. The patient has tried and failed triptans, NSAIDs, anticonvulsants and antidepressant medications. Ask your Provider if Botox is right for you.
BOTULINUM TOXIN is FDA APPROVED FOR:
There is a medical necessity for Botox when the patient has tried and failed several classes of preventative medications such as antidepressants (such as amitriptyline, venlafaxine), anti-seizure medications (divalproex, topiramate, vaproic acid), beta blockers (metoprolol, propanalol), calcium channel blocks and acute treatments including analgesics/NSAIDs (acetaminophen, aspirin, diclofenac, ibuprofen, naproxen), ergot alkaloid derivatives (ergotamine, dihydroergotamine), triptans (rizatriptan, sumatriptan, zolmitriptan), opioids).
Spasticity including Cervical Dystonia - Botulinum toxin can be used to reduce spasticity or excessive muscular contractions, to relieve pain, to assist with posture and walking, to improve range of motion, to enhance the effectiveness of physical therapy, and to reduce severe spasm to allow better perineal hygiene in patients with spasticity secondary to spastic hemiplegia and hemiparesis or and dystonia. Electromyography is necessary to determine injection site(s) in face, neck and upper extremity.
Blepharospasm - Botulinum toxin injection therapy is an accepted first line treatment for patients with blepharospasm and/or hemifacial spasm. If the upper and lower lid of the same eye and/or adjacent facial muscles, or brow are injected at the same surgery, the procedure is considered to be unilateral. Bilateral procedures will only be considered when both eyes or both sides of the face are injected. Electromyography is necessary to determine injection site(s) in face, neck and upper extremity.
Achalasia - Botulinum toxin for achalasia is necessary for as the patient has not responded satisfactorily to conventional therapy; is at high risk of complication from pneumatic dilation or surgical myotomy; has had treatment failure with pneumatic dilation or surgical myotomy; had perforation from pneumatic dilation; has an epiphrenic diverticulum or hiatal hernia; or has esophageal varices. Electromyography is necessary to determine injection site(s) in face, neck and upper extremity.
Anal Fissure - Botulinum toxin is indicated for chronic anal fissure as the patient who has not responded satisfactorily to conventional therapy. Electromyography is necessary to determine injection site(s) in face, neck and upper extremity.
Hyperhidrosis - OnabotulinumtoxinA is necessary for severe primary axillary hyperhidrosis (primary focal hyperhidrosis) that is inadequately managed with topical therapy. Primary focal hyperhidrosis is due to severe sweating, beyond physiological needs; focal, visible, severe sweating of at least six (6) months duration without apparent cause with bilateral and relatively symmetric, significant impairment in daily activities, with an age of onset less than 25 years, suspect positive family history, and cessation of focal sweating during sleep. Electromyography is necessary to determine injection site(s) in face, neck and upper extremity.
Sialorrhea – Botox is necessary for sialorrhea due to conditions including motor neuron disease or Parkinson's disease as the patient has failed to respond to a reasonable trial of traditional therapies (eg., anticholinergics and speech therapy) or who have a contraindication to or cannot tolerate anticholinergic therapy, Electromyography is necessary to determine injection site(s) in face, neck and upper extremity.
Urinary Incontinence – The patient has Urinary incontinence due to neurogenic detrusor overactivity (NDO) commonly occurs in patients with spinal cord injuries (SCI) or neurological diseases such as multiple sclerosis (MS). Patients with NDO usually use clean intermittent self-catheterization (CIC) to empty the bladder. There are incontinence episodes that occur between catheterizations, oral anticholinergic agents are used to decrease bladder contractility and improve incontinence. OnabotulinumtoxinA is indicated for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and frequency, as the patient has had an inadequate response to or are intolerant of an anticholinergic medication. Electromyography is necessary to determine injection site(s) in face, neck and upper extremity.
Headache/Migraine - There is a medical necessity for Botox for migrainous headaches. The patient has over 15 headache days per month with each episode lasting over 12 hours with severe pain. This affects the patients activities of daily living affecting more than 5 days missed from work and volunteer activities. Botox is indicated for prophylaxis of headaches in adult patients with chronic migraines. The patient has tried and failed triptans, NSAIDs, anticonvulsants and antidepressant medications. Electromyography is necessary to determine injection site(s) in face, neck and upper extremity.
Nerve Blocks:
Headache pain may be targeted through Greater Occipital Nerve Blocks
Eye pain with associated headaches may be targeted through Supraorbital, Supratrochlear and Infraorbital Nerve Blocks
