Treatment Philosophy

Excel Pain and Spine is a privately-run practice owned and operated solely by physicians that have trained, taught, and researched at the top pain medicine institutions in the country.

Our physicians are regarded experts in the pain management field and remain involved with teaching new and advanced treatments to practicing physicians, residents, medical students, and fellows across the county.

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Treatments - Botox Injections Migraine Management


Botox® or botulinum toxin (neurotoxin) has many applications including cosmetic improvement and treatment of severe muscle spasticity. Injection of botulinum toxin (onabotulinumtoxinA) into the muscles has been shown to be effective for treatment migraine headaches. It has been approved by the FDA for chronic migraine headache prevention in patients who have failed to receive relief with medications. When injected in the muscles of the brow, eyes, forehead, side of the head and back of the head near the neck, Botox has been proven to relieve both the frequency and severity of migraine attacks. The Botox acts directly on the nerves in the muscles and causes them to relax.


How is the procedure performed?
Our team will help position you to make sure the procedure can be completed with the least amount of discomfort for you. The skin is cleansed with a sterilizing solution (chlorhexidine or alcohol) and a sterile drape is placed. Botox is mixed with sterile saline in a small syringe. Next the small needle(s) is directed to the desired location. Multiple injections are performed on each side of the head, face, and neck. During the entire procedure you will be constantly monitored by the physician. After the injection a small bandage is placed on your skin. You will be given time after the procedure to make sure you feel good and are not having side-effects before leaving the clinic.

What medication is injected?
The injection includes a combination of sterile saline and Botox.

Does the procedure hurt?
The procedure is typically well tolerated. During the procedure a pressure sensation is often experienced this typically resolves within a few minutes. Minor soreness for a week after the procedure is normal.

How long does the procedure take?
The procedure typically takes about 15 minutes to perform. Please plan on being at the clinic for about 1 hour to allow for pre- and post-procedural safety protocols.

How quickly will I get relief?
Botox begins working within 5-14 days.

How long can I expect the relief to last?
The results usually last from three to four months. Some patients have noted up to six months relief.

How often can the procedure be repeated?
Depending on results and providers discretion the injections may be repeated every 3-6 months.

What are the risks and side effects?
Risks and side effects are minimal and serious complications are rare. We take every precaution to ensure safety. Potential risks may include but are not limited to: vasovagal response (passing out), new or increased pain, infection, bleeding, permanent skin changes, allergic or unexpected drug reaction with minor or major consequences, and unintended nerve injury.

Pre-Procedure Information

Please let us know if you have an active infection, are using antibiotics, or are using blood thinners.

Should I take my normal medications as scheduled?
Yes. Continue prescribed medications as you typically take prior to procedure.

What if I am on a blood thinner or Aspirin?
Anticoagulation is often stopped for a short period of time prior to injection. Please speak with your primary physician if you take blood thinners to make sure that you can safely stop taking these medications.

Do I need a driver?
Yes. For your safety we require a driver to take you home.

Can I eat the day of the procedure?
We recommend eating a light meal if the injection is done in our clinic.

Can I get sedation or anesthesia?
No sedation is needed for neurotoxin injections.

What should I wear?
We recommend light loose-fitting clothes. Sometimes we will ask you to change into a gown.

Post-Procedure Information

When can I drive after the procedure?
We recommend resuming driving the next day.

What can I do if I am sore or have pain after the procedure?
Ice packs can be applied to the area for 20 minutes per hour. Over the counter Tylenol and Motrin can be used to aid with any discomfort.

What are my restrictions after the procedure?
Typically, you may resume light activities on the same day following your procedure. Physical therapy can be re-started within 24 hours. We recommend returning to work the day after the procedure.

When can I shower?
Showering the day of the procedure is allowed. For 24 hours you are asked to refrain from submerging or swimming in water. Keep the bandage on for one day.

When do I come back for a follow-up visit?
We follow-up with all of our patients after their procedures. We typically see patients back in 2-4 weeks.

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