Botox Goes From Wrinkles To Migraines
The drug, Botox, has become a household name in less than decade. It is used in every form of grammar from a noun to a verb to an adjective (check out Urban Dictionary) to convey the treatment of facial wrinkles to looking like one has a frozen face. Who would have conceived that the use of an injectable drug for the treatment of something as seemingly trivial as a few wrinkles would strike such a cultural phenomenon? With nearly two billion in sales annually and climbing, the thirst for a less-scowling countenance and a smoother forehead is only as limited as the population that is aging.
But Botox and the concept of ‘selective muscular weakening’ have a much longer history than its current use as a wrinkle treatment and a future that exceeds that as well. It was originally conceived as a treatment for unstoppable eye twitching (blepharospasm) and for painful and contracting muscle spasms for those with neuromuscular diseases. It’s even used in the same context for veterinary medical indications- such as the treatment of stringhalt in horses. These uses predated any cosmetic application, and its use for muscular-based problems is still undergoing medical development with great promise.
Last week, Botox was officially approved by the FDA for use in certain types of chronic migraines. For people who struggle with migraines, this could be viewed as a near-miracle cure, offering almost instant relief that is both prolonged and presents no significant side effects. For migraine sufferers that have tried and failed to get relief with every other available treatment, and who have a very specific trigger located at the base of the neck, temple, or along the brow bones above the eye, Botox injections could be immensely helpful. With the theory that it is the muscles pinching down around nerves which come out of the bone in these areas of the skull that causes the migraine pain, weakening or paralyzing these muscles relieves pressure on the nerves. Botox can be injected directly into the muscles around these nerves to produce this muscle weakening. With the pressure on the nerve relieved, the trigger for the migraine is either eliminated or significantly reduced.
Plastic surgeons have long known of the potential beneficial effects of Botox for migraine sufferers. The number one location for Botox injections is for wrinkles between the eyebrows known as the glabellar furrows, popularized in Botox Cosmetic advertisements as the ‘11’s. This facial wrinkle area is what the FDA used to approve Botox for cosmetic use in 2002. This brow area, ironically, is exactly where the supraorbital and supratrochlear nerves emerge from the brow bones. They are well known triggers for migraines that come out of the eye area. Every plastic surgeon has seen from time to time patients that comment on how their headaches have been reduced after their ‘11s’ have been ‘Botoxed’. Such observations have led plastic surgeons to try with good success the use of Botox injections at the back of the neck (occipital area) where the muscles attach to the bottom edge of the skull. This is where the greater occipital nerves come out through the muscle and can be another trigger point due to muscle compression on the nerves. Occipital-based migraines are actually more common than those of the brow or eye area.
While plastic surgery has played a contributing role in discovering this new injectable treatment option for chronic migraines, it is also leading the way to a potentially longer-lasting treatment that for some migraine sufferers may be a ‘cure’. If Botox provides a dramatic migraine reduction through these trigger point injections, then surgically removing the muscle from these nerves should produce a more permanent effect. Known as surgical decompression, it can be done through very small incisions in the scalp. Cleaning the muscle off of the nerves is really a form of ‘surgical Botox.’ Thus, the use of Botox for migraines is both a treatment (lasts about four months) and a test to prove if surgical decompression would be helpful. My experience with this type of migraine surgery over the past year has been extremely encouraging. All patients that I have decompressed have had immediate and significant reduction in their migraines. I’ll be more even more enthused if these results persist for one year or longer.
Dr. Barry Eppley