Botox® for Migraines and Tension Headaches

Migraine headache and associated headaches such as muscle contraction and chronic tension headache and neck pain are all potentially relieved with the use of BOTOX®. This medication was originally used to treat crossed eyes and later for conditions such as Blepharospasm (Uncontrollable spasm of the eyelids) and Torticollis (twisting necks). Cosmetic surgeons used BOTOX® to produce minor paralysis of facial muscles around the eyes and smooth out wrinkles. Many of the patients reported significant relief of a variety of types of headaches and various trials were instituted to prove that it works for the treatment of headache.

BOTOX ® as a Treatment for Headache

Botulinum Toxin Type A is a new therapeutic option for the preventive treatment of migraine and chronic tension type headache. It offers several advantages over current drug therapy. Injections are given every three to four months. When it is effective, the need for daily medications or acute medicines for severe attacks are significantly reduced or entirely eliminated. Headache medications can cause serious side effects on the heart, including heart attack, stroke and sleepiness. Side effects of BOTOX® injection are rare; on occasion patients get aching in injected muscles, lasting usually just a few days.

How Does BOTOX® Work on Headaches?

It is known that Botulinum toxin (BOTOX®) can partially paralyze muscles. Patients with blepharospasm and torticollis (so-called cervical dystonia) have been treated and have had significant improvement in motor activity with reduction of either the blepharospasm or the torticollis. What has been noted is that there is often a reduction in pain that is more significant than the motor effect and the pain reduction effects last longer. It is quite likely that small fibers containing pain-producing chemicals such as Substance P are affected by Botulinum toxin. It is also likely that there are other mechanisms, not yet understood, for the effect of Botulinum injections. None of these theories are yet proven. There is significant clinical evidence now that Botulinum toxin type A (BOTOX®) reduces the pain in migraine, muscle contraction headache, chronic tension headache and neck muscle spasm.

Where Do We Inject?

Muscles about the eyes and forehead are injected with small amounts of Botulinum toxin. In our practice, usually the muscles between the eyebrows and above the eyes are injected. Then injections are made into the temporal region and sometimes the jaw where the masseter muscle is located. These are the only injections made in patients who only experience frontal pain with their headaches.

On the other hand, many patients have headaches that involve the entire head, down the back of the neck, into the upper shoulders. In this situation, an additional BOTOX® is injected starting at the upper back of the neck and going down onto the shoulders. The shoulder joint is not injected. Sometimes if the pain or muscle spasm goes down between the shoulder blades we inject those muscles as well.

How do We Time the Injections and What is the Duration of Effect

The majority of studies and treatment patterns to date have been based on earlier experiences with blepharospasm in which patients usually need to be reinjected every three months. However, there are some unusual patients who need to have the blepharospasm muscles about the eye injected only once every two years. After a patient receives a Botulinum toxin injection, there may be an immediate effect just from the use of needles into muscles. Usually, patients do not begin to experience relief from their headache for two to three weeks. Thereafter, however, the effect may increase and have a duration of three to four months. When a second injection is performed, the effect appears to last longer, up to four to six months on occasion.

BOTOX® is an effective treatment for migraine. It is effective in chronic muscle tension-type headaches in over 85% of the headache population. It also is quite effective in some patients who are not responding to any migraine preventive therapy. Overall, this is believed to be an effective treatment. In many instances this is a less expensive alternative than chronic daily therapy or frequent use of triptan medications which are associated with serious side effects. BOTOX® does not work in every patient and alternative therapies must be kept in mind.

Does my insurance cover the BOTOX treatment for Migraines and Other Types of Headaches?

Unfortunately the vast majority of Insurance Companies do not cover the treatment.