Botox Injections

Q: Dr. Eppley, I am interested in Botox injections for migraines. My son has had persistent migraine headaches for the past two years. I can tell you his headaches/migraines are always in his forehead area above his eyebrows.  He never has pain in the back of his head.  I have done extensive research and it seems that neurologists always do shots over the entire head and neck, like 31 injections!  That just doesn’t seem right to me.  His current neurologist recommended another neurologist, but I am hesitant to use him for this reason, even though it would probably be covered with insurance. Any information you can provide is greatly appreciated.

A: The migraines types that respond best to either Botox injections or surgery are those that are focal. This means there is one specific focus or location where the origin of the migraine can be identified. There are four well known extracranial foci of migraines, one of which is the supraorbital region of the brows where the nerve exits the bone. This sounds precisely as to what type of migraine your son has.

Botox injections for frontal-based migraines should be directly around the supraorbital nerve….and not anywhere else. I would agree that neurologists tend to use a shotgun approach and put it all around the head. This is not the injection approach for your son to determine the effect of chemodenervation and it is certainly not a cost-effective one either.

Dr. Barry Eppley

Indianapolis, Indiana