Botox - Can it work/not work depending on administration?

I am in the process of seeing if I need migraine surgery. My surgeon wants to do Botox on me to see if I am a good candidate for the surgery. Personally, I have already gone through 3 rounds of Botox (2 rounds worked, 1 didn't). When I raised this issue to him, he said that it all depends on the skill level of the administrator and that will determine how well the Botox works. Apparently, he is pretty good at what he does and wants to see firsthand if the way he performs Botox gives me any relief compared to how I have gotten it in the past.

I just need help asap because I have chronic headaches/migraines; basically I am in pain every day. I am really wanting the surgery and until I get it (or if I do), this next Botox round needs to work so I can get some relief and stop taking so many OTC medications. My fear is I have rebound headaches but I can't stop my medication until I get somesort of relief. So frustrating!

I agree I've heard the skill level makes a big difference in the potential results. That may even explain why sometimes someone doesn't respond some of the time. What type of migraine surgery are you considering? There are several I know of. I'd be very cautious regarding the surgery if it is something that physically deals with the nerves, as there is a chance to end up in even more pain.

I would want to see a good amount of published data, talk to other patients (and not just the one who had the best outcome of all of them), etc. Cost is another consideration--I don't know of any procedure that is FDA approved, so getting insurance to approve it would be on appeal, and with a lot of luck. Despite what certain doctors may say, nothing is a sure thing.

My personal opinion is that a nerve stimulator (occipital + supraorbital) is a safer surgical bet that anything that severs nerves, but even that has a lot of risks and little data showing the true chance of relief. Surgery results also vary depending on surgeon skill, and probably even whether they are having a good or bad day, etc.

Sorry you are struggling so much. Can you be admitted to the hospital for some IVs, try a steroid pack, or try some new preventative or abortive? Sometimes just the hope of trying a new med keeps me going, even if it doesn't end up working. Best wishes.

I have read about some people having fantastic results with BOTOX and some having no change at all. BOTOX didn't get cleared for reimbursement and the lady who got relief had to pay. She couldn't afford to repeat it after 6 months.

Surgical Intervention (Deep Brain Stimulation) In 2009, a French randomized, double-blinded trial comparing active to sham stimulation was published.[9] Eleven patients with CCH (Cluster Headaches) underwent DBS implantation. The randomized phase occurred during the first 2 months. No difference between sham and active stimulation could be detected during this time.

One of the 11 patients developed a subcutaneous infection which required explantation followed by re-implantation. Another patient had a transient loss of consciousness preoperatively and hemiparesis after test stimulation. A computerized tomography head was normal. This patient then developed severe micturition syncope during the study's open phase.