Botox for migraine headaches
What are migraine trigger sites?
A trigger site is a spot in your head or neck where a nerve is being compressed, squeezed or irritated. This can cause that nerve to release painful signals that travel to your brain and trigger a migraine headache.
There are several potential migraine trigger sites in the head and neck:
1) Frontal trigger site: This trigger site causes pain that starts in the forehead and brow region. It includes the supraorbital nerve and supratrochlear nerve on each side. These nerves come out of the top of the eye socket, travel through the muscles of the brow and forehead, and continue upward towards the scalp. These nerves may be compressed by bone, muscle or tight bands of tissue (fascia), leading to migraine headaches.
2) Occipital trigger site: This trigger site causes pain that starts in the back of the neck and scalp. It includes the greater occipital nerve, the lesser occipital nerve, and the third occipital nerve. These nerves may be compressed by blood vessels, muscle or tight bands of fascia.
3) Temporal trigger site: This trigger site causes pain that starts in the temples and near the hairline on the sides of the head. It includes the zygomaticotemporal nerve and the auriculotemporal nerve. These nerves may be compressed by blood vessels, muscle or tight bands of fascia.
4) Rhinogenic trigger site: This trigger site is located inside the nose. It may be due to a deviated septum, or an enlarged turbinate, causing compression inside the nose, and leading to migraine headaches that start behind the eyes. The treatment of this type of migraine headache is septoplasty and turbinate reduction.
How does Botox help migraines?
Botulinum toxin (Botox) works in 2 ways
Botulinum toxin prevents contraction of muscles that compress nerves
Botulinum toxin prevents transmission of pain signals along the compressed nerve
How many injections are involved?
Dr. Grewal and Dr. Khansa use very small needles to inject Botox at 7 spots: 3 in the forehead, 1 in each temple, and 2 in the back of the neck.
What is the evidence that Botox helps migraine headaches?
Functional outcomes between headache surgery and targeted botox injections: A prospective multicenter pilot study
OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program
This was a randomized-controlled trial that included 1384 subjects randomized to Botox (688) or placebo (696). Subjects who received Botox had a much greater decrease in migraine frequency and severity than those who received placebo.
Many studies have demonstrated that Botox is very effective for migraine headaches. Below are two major studies:
How about surgery for migraines?
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