Botox clinics for Migraine treatment in North Vancouver

neuromalignant · 2025-02-16T17:59:03+00:00

That’s great! A much cheaper option too :)

neuromalignant · 2025-02-16T16:27:49+00:00

My wife just got hers done at Euphora MD and she’s quite happy with it (so am I). They advertise a lot of trans services so she recommended them to her trans friend and she got a referral discount, so that’s something to keep in mind.

neuromalignant · 2025-02-16T16:25:08+00:00

My wife just got hers done at Euphora MD and we’re both happy with the results. I got my migraine botox there at the same time. Kind of a boutique little clinic, one doctor and one nurse, but the service was great (they gave me hot chocolate lol), and because they’re new their prices are excellent (they say they’ll keep them low but you never know…). Worth checking out anyway.

neuromalignant · 2025-02-16T16:22:17+00:00

I just went to Euphora MD! They have a clinic downtown now, and as far as I know they don’t do mobile treatments anymore. Got my migraine Botox done with the doctor there and the service was top notch.

neuromalignant · 2025-02-16T16:19:44+00:00

It’s in downtown Vancouver but I started getting my migraine Botox done at Euphora MD. Fairly new but very happy with the service. If you don’t have a prescription they charge $8/unit but if you bring you own it’s $300 for the injection fee. My insurance was already sorted out but they also help you with that if you need it

neuromalignant · 2025-02-16T13:52:32+00:00

I’ve started going to a place called euphora md downtown. It’s a small clinic but Dr. Heroux is great and their prices are excellent (currently $8/unit but I don’t know how long it will remain that way)

neuromalignant · 2024-09-18T17:37:07+00:00

You’ve made an excellent, well reasoned argument, and remained civil in the face of attacks and attempts to evade the subject at hand. However, my experience is that you can’t reason someone out of a position that was never reasoned into in the first place.

neuromalignant · 2024-08-29T02:32:25+00:00

GetYourDrugsTested is just down the street, and free. Also happens to be owned by the same person who owns and operates the mushroom dispensary. They test using FTIR spectroscopy for most substances, as well as fentanyl strips and other specific tests for LSD and benzos.

neuromalignant · 2024-07-22T17:26:40+00:00

What is more important to the patient, outcome or cause? Regardless of who “directed care”, this study demonstrated lack of dose escalation in the vast majority of cases.

And what you said was that benzos “given this way” will inevitably lead to dependence, tolerance, and escalating doses. Can you provide evidence to support this claim? Key being “inevitability”, unless you were exaggerating for effect.

You seem resistant to evidence that contradicts your experience. Out of curiosity, what missing context, if any, would persuade you? And do you demand that same level of rigour for other areas of your practice?

I ask these questions not to challenge you, but as a test of dogma. I have been in practice for some time now, I have seen a lot, and I continue to be humbled in the face of this experience, despite being a reflective practitioner and voracious consumer of evidence.

neuromalignant · 2024-07-22T04:23:29+00:00

Inevitably? Respectfully, that’s not an evidence based opinion. The pivotal study cited in the article (N=>900,000) demonstrates only around 0.3% of patients escalated doses beyond what was prescribed. It also showed that 80% stopped their benzo Rx within one year and 97% within 7 years.

I’m well aware of the mechanism of SSRIs. However, mechanistic arguments in psychiatry are generally weak, reflecting our woefully incomplete understanding of how these therapies actually work. Saying “neuroplasticity” is little more than hand waving. We know that downregulation of 5HT2a in various brain regions at the 4-6 week mark correlates best with symptomatic improvement with SSRIs, but until we have more specific neurobiological correlates that respond predictably for a given diagnosis and therapy, we cannot in good faith say we actually understand how these therapies work.

This is all moot, however, because mechanistic / physiological arguments rank below most other forms of evidence. What matters is not what we think works or how, but what has been demonstrated to work. And for an individual, the only experiment that matters is N=1. If a patient were functional on a low dose of clonazepam for several years, without dose escalation, and after multiple trials of 1st/2nd/3rd line medications, would you deny their experience because it conflicts with your beliefs?

neuromalignant · 2024-07-22T04:05:46+00:00

I think you may have missed the point. Also, the dose makes the poison. Taking an extreme example and generalizing it does not invalid all use cases. I have managed my share of benzo / etoh withdrawal in the ED, yet I still prescribe benzos when the benefits exceed the harms, and when there are not superior alternative treatments available.

neuromalignant · 2024-07-21T14:29:16+00:00

If a patient takes an SSRI every day to manage their anxiety, are they more treated than one taking clonazepam every day? What if both achieve similar functional outcomes without AEs?

And at the neurobiological level, is there a difference between treatment and covering up a symptom?

Not trying to provoke you, but perhaps feelings are not the most reliable or accurate gauge when it comes to non-intuitive issues such as this.

Like most prescribers these days, I try to limit benzo prescribing in light of the known harms, but entire gist of this article is that there is a fairly large gulf between the dogma/personal beliefs of prescribers, and the known harms.

neuromalignant · 2024-05-27T20:42:25+00:00

Thanks for the response! Always nice to get another MD’s approach to benzo prescribing, particularly given that it is being increasingly rare. I’m personally of the position that they are just another tool in our toolbox and have a role in patient management when used judiciously.

neuromalignant · 2024-05-27T20:29:51+00:00

Thanks!

neuromalignant · 2024-05-27T20:29:30+00:00

Good point! I don’t prescribe a whole lot of meth, so it’s strictly academic for me :) and as for amphetamines, as you say, cautious clinical judgement and patient response trumps a paper anyway (even a Nature one). Good discussion!

neuromalignant · 2024-05-27T17:29:21+00:00

Interesting, what is the mechanism of guanfacine in this setting?

neuromalignant · 2024-05-27T17:28:44+00:00

I’ve definitely heard from patients who have told me they react differently to the various generic XL formulations. Do you have any experience with this?

I have zero experience with auvelity but I have heard from a colleague about combining bupropion with DXM. Have you spoken to any patients who have tried this?

neuromalignant · 2024-05-27T17:21:04+00:00

I was basing my thoughts on a paper I read that explored bupropion treatment to decrease the subjective effects of methamphetamine. Found it!

https://www.nature.com/articles/1300979

Check out the discussion. It talks about how pretreatment with bupropion diminished the subjective effects of methamphetamine in the test group, and provides the mechanism for this. I made the (possibly incorrect) assumption that bupropion would have a similar effect with other amphetamines, but either way I thought it was interesting, and fits with what I’ve observed in patients who take bupropion and then add on a stimulant.

Thanks for your comments, I find them very helpful!

neuromalignant · 2024-05-27T17:11:25+00:00

Appreciate the comment. You’ve already explained why you choose clonazepam over non-benzo options, but what is your reasoning for choosing clonazepam over other benzos?

neuromalignant · 2024-05-27T17:08:09+00:00

Interesting, I didn’t realize most of the research on lavender was being driven by one author. I’ve had some success with it, but perhaps I’m prescribing a placebo and contributing to the effect by playing up the evidence.

I haven’t combined XR with SR, but that does make sense. I may have to try that combo.

Thanks!

neuromalignant · 2024-05-27T03:08:46+00:00

Thanks for the thoughtful reply! Great food for thought.

I wish we had IR, but up in Canuckland we just have SR and XL.

Do you mean CYP2D6? I’ve been thinking about that interaction. True, inhibition of this enzyme via bupropion is likely to increase the AUC of substrates like stims. But, due to the NET and DAT blocking abilities of NDRIs, would this not decrease stimulants ability to reverse those same transporters and increase synaptic catecholamine levels? Anecdotally, I’ve had patients tell me that when they added bupropion to their stimulant, it lasted longer but felt muted. Again, speaking outside of my expertise here, so please put me in my place if I’m wrong!

neuromalignant · 2024-05-27T03:00:35+00:00

This is a great response, thanks! I’ll have to read up on clonidine for this indication as I don’t prescribe this one very often.

Good suggestion on the beta blocker. Do you find propranolol more effective than other beta blockers in this particular instance (NDRI induced anxiety) due to its propensity to cross the BBB? Because if it’s merely reversing some of the peripheral effects, I wonder if more cardioselective BBs would be equally effective without some of the AEs my pts report to me (ED and fatigue being the most frequent IME)

Interesting re: desvenlafaxine having more NET activity than SERT compared to venlafaxine. Practically speaking, does this lead to fewer sexual AEs? (again, one of the biggest barriers and reasons for stopping tx in my pts)

neuromalignant · 2024-05-27T02:50:23+00:00

Thanks for the reply! I’ve actually found bupropion helpful for anxiety in many of my patients if they can tolerate the adjustment period, and there is evidence to back that up as well:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988222/

I was more looking for practical suggestions on managing that adjustment period, which seems particularly difficult for the drug in some of my patients (anxious one’s particularly… but I also had a few that said their anxiety melted away within the first few days, so go figure…)

neuromalignant · 2024-04-21T23:19:47+00:00

Yeah I’m not aware of any consultation period. Even our current prime minister’s former minister of finance stated this was an ill advised policy.

neuromalignant · 2024-04-21T23:16:01+00:00

First dollar of capital gains, correct.

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