Botox Injections

Procedure Note – Botox Injection for Chronic Migraine
Date: ***
Time: ***
Provider: *** Pre-Procedure
Indication: Chronic migraine (≥15 headache days/month, ≥4 hours/day)
Diagnosis Code: ***
Informed Consent: Obtained after discussion of risks, benefits, and alternatives.
Allergies: Reviewed
Pre-Procedure Assessment: No contraindications noted (e.g., infection, myasthenia gravis, neuromuscular disorder) Procedure Details
Preparation:
  • Patient seated comfortably
  • PREEMPT protocol followed
  • Injection sites cleaned with alcohol swabs Medication:
  • Botulinum toxin type A (onabotulinumtoxinA)
  • Total Dose: 155 units
  • Dilution: 100 units in *** mL preservative-free normal saline Injection Sites and Doses:
  • Frontalis: 4 sites × 5 U
  • Glabellar region: 3 sites × 5 U
  • Temporalis: 8 sites × 5 U
  • Occipitalis: 6 sites × 5 U
  • Cervical paraspinals: 4 sites × 5 U
  • Trapezius: 6 sites × 5 U Technique:
  • 31-gauge, 0.5-inch needle
  • Injections at 90° angle into target muscles
  • Aspiration performed before each injection
  • Procedure tolerated with minimal discomfort Post-Procedure:
  • No complications noted
  • Advised that onset may take 7-14 days
  • Return in 12 weeks if indicated
  • Avoid rubbing sites, lying flat for 4 hours, or strenuous activity for 24 hours
  • Reviewed signs of botulinum spread Disposition: Patient tolerated procedure well and was discharged in stable condition.
Signed: ***

Botox Injection Sites Poster

Migraine Daily Tracker

Print and hand to patient

Patient Information Printout

Botox Injection Billing

Botox Injection Video – by Abbvie

Additional resources:

Botox for chronic migraine booklet for healthcare professionals 

Patient Handout – Migraine (How it works)

Patient Handout – Migraine (What to expect)