Chiropractic care is a common treatment sought by patients with headaches. As some patients may not benefit from this care, chiropractors must be aware of alternative management options. Botox has more recently become a common treatment for headaches. A case of a 45-year-old female with chronic headaches and neck pain is presented. After lengthy trials of chiropractic manipulation, trigger point therapy, and acupuncture, the patient was treated with Botox-A. She experienced pain relief following the initial treatment that lasted up to 3–4 months and has since undergone subsequent trials of Botox with the same results. No side effects were experienced. As more health care practitioners are recommending Botox, the need for a better understanding of the evidence and criteria for referral for Botox treatment is required. As such, chiropractors should consider this alternative approach to managing headaches when chiropractic management is unsuccessful.

Botox-A is the serotype of a neurotoxin which, when combined with non-toxic proteins can be utilized for therapeutic purposes. It is injected into a target tissue and flaccid paralysis occurs, which decreases muscle hyper-activity and ultimately decreases pain within a short time frame. At the present time, Botox injection for pain management remains somewhat controversial, and more RCT studies as well as studies of the long term outcomes and outcome measures are necessary.
A case of a 45-year-old woman who was treated with Botox-A for chronic neck pain and headaches is presented. She was initially treated with conservative care including manipulation, acupuncture and trigger point therapy, however, this only provided short-term relief. Following Botox-A treatment she experienced pain relief immediately which lasted up to 4 months. She has been receiving Botox-A injections approximately every 4 months for one year and has noticed an increase in energy and overall improvements in her normal daily activities. This case illustrates the importance of having alternatives to conservative treatment for chiropractors. Development of a research proposal is suggested for the next steps in creating guidelines that can be utilized by chiropractors and other professionals in determining suitable candidates for this treatment alternative.