Diagnosis: Chronic migraines
Treatment: Botox
The requested Botox is not medically necessary.

There are no high quality clinical trials or standard of care guidelines supporting the safety and efficacy of a CGRP agent, such as Emgality, used as an adjuvant to Botox for the treatment of migraine headache disorder. The clinical trial leading to the Food and Drug Administration (FDA) approval of Emgality excluded persons treated with Botox. Therefore the safety and efficacy of the combination of Botox with Emgality remains undetermined.