How To Spell Migraine Relief: B-O-T-O-X

Just yesterday, Michelle, a Botox patient, told me that she has not had a severe migraine headache for the last 10 years that she has had treatments for her frown lines. She tells me that when she begins to see the wrinkles return, she begins to have more slight migraines.  Michelle says her migraine headaches used to “lay me out” for up to a week.  She is so happy with her Botox treatments, both for the cosmetic improvement and in stopping her migraines from recurring.  I have heard this time and again.  What is going on?

Recently, the FDA approved the use of Botox for migraine headaches. This has always made sense to me from a anatomical standpoint.  Botox works by paralyzing muscles involved in facial animation.  The most common area is the corrugator or frown line muscles located above the eyebrows.  Botox is injected into the muscles, the muscles relax, and so do the creases in the skin they cause.

There are two cranial nerves that pass through this frown line muscle.  These are sensory nerves that travel directly to the base of the brain.  So with tense muscles around these nerves, there is an irritation that can develop into a migraine headache.  With Botox, the muscle is relaxed and the nerve irritation is reduced.  There are other areas of muscle irritation that leads to migraines in the temple and at the back base of the head.  These can also be treated with Botox.

The FDA approval is for patients who have at least chronic migraine headaches: 15 migraine headaches in a month lasting at least 4 hours.  This is the group of patients that was studied.  The FDA points our that Botox has not been shown to work for patient who have 14 migraine headaches or less a month.  This doesn’t mean that it does not work for these patients, it means this group of patients have not been study yet.  Anecdotally, most of my migraine sufferers have a decrease or cessation of there migraines, even if the migraines occur only “once in a while”.

Another development for treatment of migraine headaches is surgical treatment. I perform corrugator muscle removal for permanent decrease in the frown lines in my Fort Wayne plastic surgery office.  It turns out that removing a part of these muscles around the sensory nerves and replacing this area with fat graft is successful in decreasing migraines in over 90 percent of patients.  Again, like Botox, a cosmetic procedure that can help with a medical problem.   Although often an uphill battle, particularly because these are relatively new procedures for migraine headaches, insurance may cover Botox or surgery for medically documented migraine sufferers.  The best place to start is a neurologist to make the diagnosis and referral to a plastic surgeon who performs these procedures.