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Migraine headaches can steal your life and wellbeing,  The pain, dysfunction and nausea all come at the worst of times. Treatment options, like Botox are expensive.  What is Botox?  How does Botox work?  What are the side effects of Botox for migraines?  Are there better, natural options?   Let’s dig in.

What is Botox?

Botulinum toxin also known as Botox is a nerve toxin (poison) produced by bacterium Clostridium botulinum (1).  It prevents the release of a neurotransmitter that is essential to muscle function (2).  The result is muscle paralysis. There are multiple types of botulinum toxins, named type A–G.  Types A and B are used commercially for medical and cosmetic purposes. Different commercial brands exist and include Botox, Dysport, Jeuveau, and Xeomin.  Medical indications for Botulinum toxin include (3):

  • Overactive Muscles (Muscle Spasticity)
  • Cross eyes (Strabismus)
  • Excessive sweating
  • Abnormal muscle pain and twitching in the neck (cervical dystonia)
  • Wrinkles

Does Botox Treat Migraines?

Botulinum toxin is currently approved for the treatment and management of migraine headaches.  The toxin blocks important neurotransmitters and pain signals resulting in the reduction of pain and a decrease in the frequency of headaches. (4)  The toxin only lasts several months and in most cases, patients require additional treatments.

Where Do they Inject Botox for Migraines?

There are a number of different treatment protocols for migraine treatment which include Anatomical Regional Targeted (ART) (5) and Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) (6).  The later is the most popular and involves 31 injections of botulinum toxin.  Areas injected include the forehead, temples, the bridge of the nose, back of the head, neck, and shoulders as illustrated in pictures below.  Each black circle is an injection site for the toxin.  Ouch!

Side Effects of Botox for Migraines

Problems can and do arise with the injection of Botox for migraines due to dosing issues and unintentional spread of the toxin.

Dosage

Side effects from Botox can be significant and in 2005  included 28 deaths (7).   Thirty-three percent of the adverse events were related to off-label use of Botox and none involved the use of Botox for cosmetics.  In 2009 the FDA imposed strict new labeling requirements to improve safety (8).

Unintentional  Spread

Because Botox is a liquid it can spread beyond the area of injection.  Remember when you painted the trim in your bedroom?  Try as you might to have a steady hand it is very challenging to keep the colored paint off the white trim and baseboard.  So too with Botox.  Because it is a liquid it can spread to areas beyond the injection site.  It can spread to other important muscles with resultant weakness. Important examples include:

  • Eye weakness,
  • Drooping eyebrows
  • Difficulty supporting your head (Heavy Head)

The toxin can also spread into the bloodstream causing serious symptoms including (9):

  • Muscle stiffness
  • Neck pain
  • Dry mouth
  • Headache and fatigue
  • Breathing problems
  • Difficulty swallowing

Regenerative Medicine Treatment Options

At the Centeno-Schultz Clinic, we are experts in interventional orthopedics and focus exclusively on using your body’s own healing agents to address injury and dysfunction.  Paralysis of muscles using toxins has significant side effects discussed above.  In some cases, it can make the symptoms worse as patients are unable to keep their heads upright due to toxin-induced weakness.  Most importantly the underlying cause for a patient’s headache is not evaluated or treated.  Common causes of headaches include:

  • Cervical Disc Injuries
  • Cervical Facet Injuries
  • Loose ligaments with Instability
  • Compression or Entrapment of Occipital Nerves
  • Head Forward Posture with excessive pressure on facets, discs, and nerves

PRP and bone marrow concentrate can be precisely injected into targeted areas to promote your body’s ability to heal.  PRP and bone marrow concentrate are rich in growth factors that can increase blood flow and decrease inflammation thereby accelerating your body’s healing.  The injections are demanding and require extensive training and expertise.  Your PCP or neurologist can not perform these injections.  To better understand the level of skill required please click on the video below which reviews x-ray guided injections of the cervical facets.

 

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In Conclusion

Botox is a type of Botulinum toxin that prevents the release of important muscle neurotransmitters that results in muscle paralysis.  Botox and other types of Botulinum toxins are used for medical and cosmetic indications which include the treatment of migraines.  Different treatment protocols for the treatment of migraines exist and involve multiple injections in the face, neck, and head.  What are the side effects of Botox for Migraines? Repeat injections are necessary as the effects of the toxin are transient.  Complications exist and include dosing errors and unintentional spread of the toxin into adjacent muscles and potentially the bloodstream.    At the Centeno-Schultz Clinic, we are experts in regenerative medicine and headaches.  We acknowledge and so should you that there are many different causes for headaches that should be evaluated and treated.  Paralyzing muscles does not address the underlying problem.  PRP and bone marrow concentrate are effective, natural treatment options for headaches that do not involve the risks associated with Botox

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1.Choi YJ, Lee WJ, Lee HJ, Lee KW, Kim HJ, Hu KS. Effective Botulinum Toxin Injection Guide for Treatment of Temporal Headache. Toxins (Basel). 2016;8(9):E265.doi: 10.3390/toxins8090265

2.Frampton JE, Easthope SE. Botulinum toxin A (Botox Cosmetic): a review of its use in the treatment of glabellar frown lines. Am J Clin Dermatol. 2003;4(10):709-25.DOI: 10.2165/00128071-200304100-00005.

3.Sprenger T, Viana M, Tassorelli C. Current Prophylactic Medications for Migraine and Their Potential Mechanisms of Action. Neurotherapeutics. 2018;15(2):313-23.DOI: 10.1007/s13311-018-0621-8.

4. Ramachandran R, Yaksh TL. Therapeutic use of botulinum toxin in migraine: mechanisms of action. Br J Pharmacol. 2014;171(18):4177-92.DOI: 10.1111/bph.12763.

5.Amirlak B, Sanniec K, Pezeshk R, Chung M. Anatomical Regional Targeted (ART) BOTOX Injection Technique: A Novel Paradigm for Migraines and Chronic Headaches. Plast Reconstr Surg Glob Open. 2016;4(12):e1194. doi: 10.1097/GOX.0000000000001194,

6.Aurora SK, Dodick DW, Diener HC, et al. OnabotulinumtoxinA for chronic migraine: efficacy, safety, and tolerability in patients who received all five treatment cycles in the PREEMPT clinical program. Acta Neurol Scand. 2014;129(1):61-70. doi: 10.1111/ane.1217101/

7. Batra RS, Dover JS, Arndt KA. Adverse event reporting for botulinum toxin type A. J Am Acad Dermatol. 2005;53(6):1080-2.

8. https://blogs.scientificamerican.com/news-blog/fda-acts-on-risks-that-botox-effect-2009-05.

9. Blackie JD, Lees AJ. Botulinum toxin treatment in spasmodic torticollis. J Neurol Neurosurg Psychiatry. 1990;53(8):640-3.DOI: 10.1136/jnnp.53.8.640