Traditional therapies for migraine headaches include avoidance of migraine triggers, medications such as Imitrex. Some patients do not respond to these therapies or may not tolerate the medications.
Who is a Candidate?
If you have 15 or more headache days per month, lasting more than 4 hours per day, you are a candidate for Botox
Botox (Onabotulinum toxin A) is derived from the Clostridium botulinum bacteria. This toxin is naturally found in spoiled canned food, and if eaten, can cause a deadly reaction called botulism (deadly muscle paralysis).
Botox works by blocking nerve transmissions from one nerve to another, which decreases the signal to the muscle to contract. This relaxation of the muscles results in interruption of the headache pain pathways. The FDA approved Botox for migraine headache treatment in 2010.
Using Botox for Migraines
Botox injections in the face help smooth out wrinkles because it relaxes facial muscles. It can also help relax muscle spasms related to tics and the disease cerebral palsy. People who were treated for facial wrinkles with Botox reported that they got relief of migraine headache pain, so it was investigated as a treatment for migraine.
The procedure: a tiny injection of Botox is placed in various sites on the face, head, neck and upper back. Muscle relaxation and pain reduction can take up to 10 days for muscle-relaxing effects and lasts approximately 3 months. Repeat injections are recommended every 12 weeks. It may take up to 6 months to show maximum benefits.
What Muscles are Treated?
1. Frown muscles (Corrugators and Procerus): between and at the inner end of eyebrows
2. Frontalis: forehead muscles which produce horizontal lines on the forehead
3. Temporalis: muscles of chewing in the temple area
4. Occipitals: where neck muscles attach to the back of the skull
5. Cervical Paraspinals: top and back of the neck
6. Trapezius: upper back and neck muscles
Possible Botox Side Effects
There are about 5% in treated patients as compared to patients treated with placebo (3%)
• Muscle Weakness
• Upper Eyelid Droop
• Numbness or pins-and-needles sensation
• Skin tightness
• Neck stiffness
• Neck pain or soreness
• Headache – usually short-lived
Rare Side Effects
• Problems swallowing, speaking or breathing
• More widespread loss of muscle strength, double vision, drooping eyelids, hoarseness, loss of bladder control
- Botox injected in head ‘trigger point’ shown to reduce migraine crises
- OnabotulinumtoxinA for chronic migraine: a critical appraisal