Treatment
Therapeutic injections
Not every use of a neuromodulator is cosmetic. Some of this work treats a diagnosed medical condition. Patients presenting for these treatments should already have a diagnosis of the below conditions from their primary care provider.
Therapeutic neuromodulator injections are typically not a first line treatment, and are offered as a treatment option only after multiple other treatments have failed.
How it works
Therapeutic treatment always takes two appointments. It is never done on the day you first come in.
Consultation
A full assessment to confirm you have been diagnosed with this medical condition and other medical conditions that could cause your concerns have been ruled out.
Prescription
If treatment is appropriate, a prescription will be sent to our partnering pharmacy so the medication is ready for your treatment date. The cost of the medication is determined by your personal coverage plan and payment for any prescription costs is the patient’s responsibility.
Treatment
The neuromodulators will be dispensed to the clinic directly, and prepared for you on the treatment day.
Hyperhidrosis — underarms
I treat the underarms (arm pits) only, and only after a diagnosis of primary focal axillary hyperhidrosis has been made. That usually means testing through your primary care provider first, to rule out an underlying cause of excessive sweating, such as a thyroid disorder.
Neuromodulators are not a first-line treatment for axillary hyperhidrosis.
Non-medication treatment options
- Antiperspirants (aluminum based)
Medication treatment options
- Oxybutynin
- Glycopyrrolate
- Topical Glycopyrronium
Neuromodulator injections are considered after topical antiperspirants and/or a trial of oral medication, such as oxybutynin, have been tried and were not effective, or were not tolerated.
Treatment response is usually evident within 2–4 days after injections and improvement in sweating can range from 3–9 months, with an average duration of about 6 months.
Coverage. This treatment may be partly covered by Manitoba Health if the injections are performed by a dermatologist. If you would like to go that route, ask your primary care provider for a referral to a dermatologist.
If you would rather be treated here and you meet the criteria, I will provide a prescription and an injection fee of $200 applies.
Migraines
Migraines can be a debilitating chronic headache condition that limits your ability to function. Chronic migraines are defined as having a headache on ≥15 days per month for at least 3 consecutive months. If you have been diagnosed with chronic migraines by your provider and have failed on two or more first line interventions, you may find benefit from therapeutic neuromodulator injections.
Non-medication preventative treatment options
- Acupuncture
- Aerobic exercise
- Cognitive behavioural therapy
- Vagal nerve stimulation
Medication preventative treatment options
- Beta-blockers (ex. propranolol)
- Tricyclic antidepressants (ex. amitriptyline)
- Anticonvulsants (ex. topiramate)
Supplementation
Some patients find the following supplements helpful alongside other migraine management:
- Co-Enzyme Q10 — 100mg three times daily
- Magnesium Glycinate — 400–600mg daily
- Vitamin B2 (Riboflavin) — 400mg daily
Coverage. This treatment may be partly covered by Manitoba Health if you meet the criteria and the injections are performed by a neurologist. That route requires a referral from your primary care provider — please note I do not provide these referrals.
If you would rather be treated here, I will provide a prescription and an injection fee of $200 applies.
TMJ and jaw tension (off-label)
Treating the masseter muscle can reduce clenching and grinding, ease jaw ache and headaches that come from the jaw. Over time after repeated injections, it can also reduce the muscle bulk that develops from years of overuse.
Neuromodulator injections are not a first-line treatment for TMJ. Prior to therapeutic and prescribed neuromodulator injections, the patient should have failed on first line treatments.
Non-medication first-line treatments
- Dental devices (discuss with your dentist)
- Physiotherapy
Medication treatments
- NSAIDs (ex: ibuprofen, naproxen, etc)
- Tricyclic antidepressants (ex: Amitriptyline)
- Muscle relaxants (ex: cyclobenzaprine)
Failure on one or more of the above interventions after a confirmed diagnosis of TMJ would qualify you for trialing neuromodulator injections.
Pricing note. TMJ is currently offered as an off-label indication. Because it does not go through a prescription, it is priced at $8 per unit rather than the standard $10 per unit.
Aftercare
Click here for aftercare
The same instructions I hand you in clinic.
You'll start to see effects in 2–5 days. Full results are in at 2 weeks and typically last 3–4 months. If a touch-up is needed, it should happen at the 2 week mark.
Common side effects
Swelling, bruising, redness, discolouration, itching and tenderness at the injection sites.
For 1 hour
- Move the muscles that were treated
For 3 hours
- Stay upright
- Don't rub the treated areas
For 6 hours
- No makeup on the treated areas
For 24 hours
- No strenuous physical activity
- No hot tubs, saunas or facials
- No alcohol
- No Advil or Aspirin
Worried about something after a treatment? Call the clinic on 204-416-5433.
What it costs
A consultation is always required first. For hyperhidrosis and migraines, where you meet the criteria, I provide a prescription and charge an injection fee of $200 at the treatment appointment.
The medication is a separate cost. It is dispensed through the pharmacy, and the cost of the product falls to you or your health coverage plan. That is in addition to the injection fee, not included in it.
TMJ, an off-label indication, is priced per unit at $8. The number of units depends on the presentation.
All prices are subject to GST.