Treatment for chronic migraine uses a standardised pattern of multiple small injections across defined sites on the forehead, temples, back of the head, neck and upper shoulders. The pattern is fixed by protocol rather than improvised, though individual sites can be adjusted between cycles.
Treatment for chronic migraine uses a standardised pattern of multiple small injections across defined sites on the forehead, temples, back of the head, neck and upper shoulders. The pattern is fixed by protocol rather than improvised, though individual sites can be adjusted between cycles.
The injection sites and the approach are standardised, covering muscle groups across the forehead, temples, the back of the head, the neck and the upper shoulders on both sides. That standardisation is part of why the treatment should be given by someone trained in this specific protocol rather than in cosmetic use, which uses different sites for a different purpose. The total is a series of small injections rather than one or two.
The mechanism is thought to involve dampening pain signalling from nerve endings across the areas involved in migraine, which means covering a distribution rather than treating a single point. Each individual injection is small and quick. Most people find the whole sequence more tolerable than the number suggests, partly because each one is brief and partly because the needle used is fine.
Although the pattern is standardised, individual sites can be modified at subsequent cycles if one produced a troublesome effect, such as an eyebrow sitting unevenly or particular neck stiffness. That is a reason to report effects between cycles rather than waiting to be asked, since the adjustment can only be made if somebody knows. Injections are given in the office at either location, and this practice performs no surgery.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: American Academy of Neurology; MedlinePlus: migraine; National Institute of Neurological Disorders and Stroke.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.