Brief Answer: Needs management an modifications Detailed Answer: Good Day XXXX Thank you for asking. I am Dr S Khan and i would like to help you with your migraine issues and recent nose bleed. Lets first talk about the nose bleed. Miss XXXXXXX epistaxis is a multi directional etiology mostly unknown for its cause in 65 % people. As you already had one deviated septum correction, I want you to seek an otorhinolaryngologist if the issue persisted. As far as botox is concerned it has nothing to do with Nasal bleeds.Botox only causes dysphagia, seizure, flulike syndrome, facial and other muscle weakness, ptosis, and skin and injection site reactions. Now the migraine of yours is a severe one and it needs a complete management from diet and lifestyle modifications to abortive, preventive and prophylactic therapies. Following dietary triggers should be avoided. Alcohol - Particularly wine and beer Caffeine overuse or caffeine withdrawal Chocolate Aspartame - eg, NutraSweet and Equal Monosodium glutamate (MSG) - May be found in Asian food, canned soup, frozen or processed foods, and the seasoning product Accent Fruits - Citrus fruits, bananas, avocados, and dried fruit Nuts - Peanuts, soy nuts, and soy sauce Tyramine, a biogenic amine that accumulates in food as it ages, may provoke migraine. Sources include the following: Dairy - Aged cheese Meat - Bacon, sausage, luncheon meat, deli meat, pepperoni, and smoked or cured meat Pickled foods Heavily yeasted breads - Eg, sourdough Vinegars - Especially wine vinegar Some types of beans Nutraceuticals shown to be effective in randomized clinical trials include the aforementioned vitamin B2, CoQ-10, magnesium, and butterbur (Petadolex) Now the Botox you mentioned is a prophylactic use and it is repeated every 2nd month for maximum 6 to 9 months. Seek your neurologist for further options like Complementary treatments( CAM techniques, Biofeedback and behavioural therapy,A herb called Butterbur(Petasites hybridus)Use of riboflavin (vitamin B2), magnesium,Melatonins, Boy works like chiro practic massages and cranio sacral therapies, Accupunctures .) Also discuss the doses rescheduling in menses as most migraines are menstrual in women And preventive agents like fravotriptans be used. If the problem persisted for more than 72 hours then seek ER help as it would need status migrainous treatment and some intravenous management. DIscuss other abotive medicine options with your neurologist like Selective serotonin receptor (5-HT1) agonists (triptans) Ergot alkaloids Analgesics Nonsteroidal anti-inflammatory drugs (NSAIDs) Combination products Antiemetics and some prophylactice / preventive options with them too like Antiepileptic drugs Beta blockers Tricyclic antidepressants Calcium channel blockers Selective serotonin reuptake inhibitors (SSRIs) NSAIDs Serotonin antagonists Botulinum toxin Miss XXXXXXX hope this answer finds you in good faith. Kindly take good care of yourself and close the discussion please. Have a good day. Regards Khan

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