So, what is a Migraine Headache?

Migraine Definition

At least 2 of the following:• Moderate to severe pain• One sided • Throbbing or pulsating in character• Worsening with movement or bending over &At least one of the following:• Nausea and/or vomiting• Sensitivity to lights, sounds or smells

Other Common Migraine Symptoms

• Precipitated by certain foods, alcohol, stress, sleep patterns• Peri-menstrual• 60% of the time involves the neck region• Strong family history (“sick headaches”)• 3:1 female• Worsened with bending over (it’s not your sinuses!)• Next day “hang-over headache”• Responds to caffeine

FAMOUS MIGRAINEURS

Botox Binds to the Nerve Terminal

Botox is Internalized into the Nerve Ending

Botox Cleaves SNAP-25(Now the nerve can’t release acetylcholine and tell the muscle to

contract, so your wrinkles are gone!)

After 3 months, new nerve sprouts develop

(and your wrinkles return)

Eventually the sprouts retract and the original nerve ending regains its normal

function(That’s why Botox is re-injected every 3 months)

Beverly Hills, CA October 15, 2010 William J. Binder M.D., F.A.C.S. Inc.,

Beverly Hills plastic surgeon and pioneer in the cosmetic (anti-wrinkle) and therapeutic use of the

BOTOX® neurotoxin, made headlines in the early 1990’s by discovering that BOTOX was effective in relieving the pain and preventing the onset of migraine headaches. Friday the U.S. Federal Drug Administration (FDA) approved BOTOX injections as a preventative treatment for chronic migraine sufferers.

Botox is only approved for “Chronic Migraine”

• • So, what constitutes a “Chronic Migraine”?

Diagnostic Criteria for Chronic Migraine

• Chronic Migraine is a defined condition1-3

• 15 or more headache days per month• Headaches lasting 4 hours per day or more• At least 8 headache days classified as migraine days• With or without medication overuse

• What are migraine characteristics1?

141. Headache Classification Committee; Olesen J et al. Cephalalgia. 2004;24:9-160.2. Headache Classification Committee; Olesen J et al. Cephalalgia. 2006;26:742-746.3. Lipton RB. Headache. 2011;51(S2):77·83.

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PAR IV Movies Presents:

• Reality vs. Insurance Companies

So, how do we inject Botox for Chronic Migraine?

BOTOX® for Chronic Migraine Patients: Recommended Order of Injection* per Phase 3 Injection Paradigm1

1. BOTOX® (onabotulinumtoxinA) Prescribing Information. Allergan, Inc., 2011.2. Blumenfeld AM et al. Headache. 2010;50:1406-1418.

Order* Muscle Total Dosage (Number of Sites**)

A Corrugator† 10 Units divided in 2 sites

B Procerus 5 Units in 1 site

C Frontalis† 20 Units divided in 4 sites

D Temporalis† 40 Units divided in 8 sites

E Occipitalis† 30 Units divided in 6 sites

F Cervical paraspinals† 20 Units divided in 4 sites

G Trapezius† 30 Units divided in 6 sites

Total number of Units 155 Units divided in 31 sites

* Recommended order of injection based on phase 3 injection paradigm; table in prescribing information differs.** Each IM injection site = 0.1 mL = 5 Units BOTOX®. † Dose distributed bilaterally.

Dosing and results in these studies are specific to the formulation of BOTOX® manufactured by Allergan, Inc. (Irvine, CA). The Allergan, Inc., formulation is not interchangeable with other botulinum toxin products and cannot be converted using a dose ratio.

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Patient is in supine position2

Patient is in sitting position2

Please see Important Safety Information, including Boxed Warning, throughout this deck.

Facial Muscles

Questions, comments,

alternative speeches