Should I Get Botox Or Surgery For My Temporal Migraines?

Q: Dr. Eppley, I would like to possibly get temporal zone migraine surgery or Botox injections.  I have been diagnosed with chronic daily headache (migraine) and believe this would be beneficial.  I have had it for approximately 3 1/2 years and normal medications and treatments do not correct the issue. The issue developed approximately 2 to 3 months after returning home from overseas.  I do wear a TMJ mouth guard for bruxism and have daily muscle tension type headaches in both temples and above the ears.  Since medications and the mouth guard do not fix the problem I believe that this procedure may provide some more permanent relief. Please feel free to email or send any additional information. Thank you.

A: By your description, it appears you have symptoms that involved both temporal and masseteric muscles. This, to me, more likely suggests myofascial pain syndrome of these muscles and fascia rather than a specific trigeminal nerve compression issue. The first place to start is with Botox injections into either the temporal or masseter muscles or both. Then see what the response is which, in my experience, I have yet to see a patient who does not get some significant reduction in their symptoms. Migraine surgery is reserved for those patients in which a specific peripheral neurovascular trigger can be found rather than overall masticatory muscle pain/headaches. That is the first place to start and is what should be done during the first visit.

Dr. Barry Eppley

Indianapolis, Indiana