Pin the Tail on the Patient: Botox Edition


A cheesy daytime court show was playing on the television mounted in the waiting room. I have noticed that, no matter where or when I go, a cheesy daytime court show is ALWAYS playing in the waiting room at every neurologist’s office. The time of my appointment (2:45 pm) came and went and I passed the time by filling out a stack of papers that explained, in detail, all of the bad things that could happen as a result of having Botox injections. Finally, I was called back into the room where my neurologist (a gruff but ultimately rather Teddy Bear-like man) asked if I knew the drill or did I have questions? “Just how many shots today and where?” I answered. “31 today, all over the head. Do you want me to tell you when I’m about to stick you?” I nodded and on the “3” of a “1, 2, 3” count, he gave the first injection in the left side of my forehead. In between saying “1, 2 3”, he chatted with me as he injected the contents of the syringes into various areas in my head. “You’re doing really well. Didn’t you have a problem with this last time?” he asked, somewhat incredulously. (You curl up into a ball of tears in the corner ONE TIME and it follows you around for the rest of your life! Geez.) “Well, I’ve had Botox three times now, four if you count this round. The first time I had it, I was pretty freaked out but now I’m generally okay.” Continuing his counting, he moved my hair out of the way and said “Sometimes I feel like a hairdresser,” as he stuck an injection into the back of my head. “You’re not flinching. You’re not even moving at all!” He sounded impressed. “It may have more to do with fear than bravery,” I responded. “I think I’m scared that, if I move, you’ll accidentally inject into the wrong spot.” He grinned. “The interesting thing is that people most often flinch toward the needle, instead of away from it. It seems counter-intuitive. But if you flinch away from the needle, it’s not too big a deal. If you flinch INTO the needle, that could cause more problems because then the Botox could end up in places we don’t want it to. Do you ever get pain in your neck or shoulders with your migraines?” he asked. I nodded. “Occasionally, my PCP does trigger point injections in my shoulders and those help sometimes.” That seemed to satisfy him and he stuck a few injections into my neck and shoulders. He stepped back and pronounced that we were done here. All of the injections had felt like a small pinch with a slight stinging sensation. For me, Botox has never been as terrifying as it looks or sounds. “Anything I should know? Or do? Or not do?” “DON’T touch your face. Don’t push on or pick at the injection sites. They will heal quickly and naturally. If you poke at them, you risk moving the Botox into a part of the body where we didn’t intend it to be.” I nodded. “You put some injections into the back of my head…what happens if I lay on those? Won’t that push on them?” I asked. He shook his head. “Shouldn’t be a problem.” “When will my face be back to normal? Like, when can I stop worrying about it?” “Tomorrow. Some people complain of slight pain at the injection sites or that their neck feels stiff after receiving an injection in the neck. But I don’t anticipate a problem since you’ve had Botox three time before without incident.” After telling him that I sometimes experience cold/flu-like symptoms after a round of Botox, he suggested I take Tylenol and Benadryl to help alleviate those discomforts. “I want to see you in 6 weeks to follow-up. At that appointment, we’ll set your next Botox injection appointment.” I thanked him and he led us out to the waiting area where I made an appointment with the desk secretary. My dad whispered to me “You did a great job. Those needles…they looked longer and like they went in deeper than I remember from last time. I thought for sure you would, understandably, tear up or flinch.” I grinned. As I write this, I’ve noticed a definite change in sensation since the procedure. At first, my forehead stung. Then, it ached. Now, three hours later, it doesn’t feel much like anything at all. My neck is a little sore but nothing I’d be concerned about. You can see a couple of red spots on my forehead but there hasn’t been any bruising yet. I’m getting tired. I’ll keep you all posted about any new developments, whether it seems to be working, etc. My main goal is to educate those who have never had Botox and to make it seem a little less scary for those who might feel hesitant about trying it.

3 thoughts on “Pin the Tail on the Patient: Botox Edition

  1. spoke with my neurologist today and they are starting the authorization process, not really looking forward to 31 needles in my head, already had nerve blocks in the back of my head and neck, tried all the meds available since we reviewed the list from a-z today and nothing is working

    Liked by 1 person

    • As I mentioned in my post, this is my fourth time having Botox injections, and all of them have been tolerable. (The first time I got them, I had worked myself into a Level 10 migraine and we had to drive through a huge New England blizzard to an office/doctor with whom we weren’t familiar.) I was crying and having a panic attack because needles terrify me and they always have. In my experience, Botox was not even 1% as scary or as painful as I had made it out to be in my mind. I had a similar experience with acupuncture, although I grew to enjoy acupuncture and look forward to my appointments, whereas the Botox injections are just something I have to get through. If you need/want any tips or further insight into the Botox procedure, feel free to e-mail me at the address listed on the “Contact Me” page. Also, don’t worry if the insurance company initially gives you a hard time or denies the prior authorization altogether. That happened to me and my doctor’s office and I had to keep pushing and appealing but we got it completely taken care of and my insurance ended up pre-authorizing four sets of injections (three months apart) which is a year of treatment, at which point we can prove it is helping (if it is) and get further injections covered. If you want any more info on the insurance aspect, I’d be happy to talk you through that, too. That’s the whole goal of my blog: to share the knowledge I’ve gained over the past eleven years with fellow migraineurs, to raise awareness for migraines amongst the general population, and to fundraise. Good luck! ~Michelle


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