First of all, my use of botulinum toxin for the preventive treatment of chronic migraine has dramatically decreased since I started working with the CGRP antibodies in the context of clinical trial research in 2012. I find them to be much more effective than botulinum toxin, equally well if not bett...

I would consider use in patients who are truly chronic and difficult to control with less risky medications. Always have a discussion with the OBGYN before you consider starting it. I've had some remarkable results using it in patients in the second and third trimesters. Weigh the pros/cons. Would i...

I have administered botox to several chronic migraineurs during their pregnancies (in all trimesters) without subsequent adverse outcomes for their neonates. Of course, this is a therapy I do not administer unless I have sufficient buy-in from the patient, in addition to their obstetrician. I have y...

I would consider using Botox in an appropriate patient during early pregnancy, but I have not done so before due to concerns about potential systemic and unexpected weakness.

I would refrain from recommending it primarily due to medical-legal considerations until more robust clinical publications on its safety are available. However, in extreme situations, I don't have any objections to it. Typically, I administer nerve blocks as needed, and in most cases, migraine patie...