Botulinum Toxin A (BTA), also known as Botox, is a very potent neurotoxin. In migraine headaches treatment it is used to selectively weaken certain muscles in the face and neck, which compress sensory nerves in the forehead, temporal region and back of the head and thus trigger migraine headaches.
On the front of the head the muscles between and above the eyebrows are targeted during migraine headaches treatment in our Caribbean plastic surgery practice at Trinidad Institute of Plastic Surgery. These muscle groups (corrugator and depressor supercilii, procerus) are the same into which Botox is injected during cosmetic treatments for facial wrinkles. On the side of the head the primary target is the muscle seen to be moving when the teeth are clenched or food is chewed (temporalis muscle). In the back of the head and neck injection is performed into one of the neck muscles helping to keep the head straight. All these muscles have in common that they are pierced by sensory nerves providing sensation to a relatively specific area of the face and head. Thus the predominant location of the migraine headaches (e. g. between the eyes, forehead above eyebrows, side or back of the head) is important to determine which muscle groups to inject. The muscles between and above the eyebrows are small requiring little more Botox during migraine headaches treatment than is injected during cosmetic wrinkle treatments. The muscles on the side and back however are larger and a higher dose of Botox is required to decrease muscle activity, nerve compression and thus migraine headaches.
With years of experience in this form of migraine headaches treatment we still find that targeted injection around the anatomic location of the nerve compression is more effective than multiple small injections in the entire muscle (which was the protocol on which the FDA based its decision to approve Botox for the use in migraine headaches treatment). Thus we inject the eyebrow muscles as we would during a cosmetic treatment with a higher dose, then inject the muscles at the side of the head in the area behind the bony eye socket and the neck muscles a bit below the skull bone at the sites, where we the sensory nerves are known to emerge from the muscles.
The procedure is performed in our office and virtually everybody with true migraine headaches can undergo the treatment with a minimal risk of tolerable side effects.
But the injections are not just a treatment, but also a test. If migraine headaches treatment with botox injections significantly decreases severity and / or frequency of migraines, it is particularly good news since migraine surgery, which permanently decompresses the nerves triggering the headaches has a very high chance of curing migraine headaches permanently.
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