The role of the primary care physician and physician extenders is indespensible in the treatment of headache, as often patients rely on them for the majority of their prescriptions. Nearly all patients seen for migraine surgical evaluations have at some point been under the care of a neurologist, though this specialty is not available in all communities. Candidates that should be considered should have been tried on preventative medications in addition to abortive therapy. Those that do not obtain relief, want to avoid undesirable side effects, or those that want to avoid taking too many medications should be considered for consultation.
This criteria usually indicates the possible efficacy of Botox® Therapeutic injections which has recently been done with the 32 injection pattern that was used by Dr. Ninan Mathew in Headache: The Journal of Head and Face Pain. While this technique appears to be better than previous injection techniques used by Neurologists prior to the FDA’s approval (usually “follow the pain” or the “bandana” pattern), it is not purposefully designed to follow the anatomy of the superficial sensory nerves (supraorbital, supratrochlear and zygomaticotemporal branches of the trigeminal nerve (CN5) or the greater occipital nerve).