Migraines are considered the most common disabling brain disorder, characterized by severe headaches that hit about 20 percent of women and 10 percent of men at some point in their lives. Migraines are commonly diagnosed as chronic if they occur 15 times per month.
Botox is a widely recognized drug made from a toxin that’s used to temporarily smooth out facial wrinkles. Nearly two decades ago, a Cleveland plastic surgeon, Bahman Guyuron, M.D., observed that certain patients with cosmetic forehead/brow lifts, or with cosmetic Botox injections, experienced an easing of their migraines.
Today, Botox is recognized as an important tool in the treatment of chronic migraines, says plastic and reconstructive surgeon Miguel A. Medina III, M.D. , director of microsurgery at Miami Cancer Institute . Additionally, those patients that improve with Botox therapy may be candidates for migraine surgery.
Dr. Medina explains that certain types of chronic migraine headaches can be caused by nerve compression. Surgery can release the pressure on the nerve from surrounding tissue. Botox and numbing agents are used to determine if such nerve compression is present in patients.
“Botox, because it relaxes the muscles around the nerves, seems to be a good bellwether for people who will respond to surgery,” says Dr. Medina, acknowledging the pioneering work by Dr. Guyuron, who has trained dozens of doctors across the nation on this type of surgery.
(Video: The Baptist Health South Florida News Team hears from Miguel A. Medina III, M.D., director of microsurgery at Miami Cancer Institute, on how Botox is used to help treat migraines. Video by Alcyene Almeida Rodrigues.)
Dr. Medina said Botox can play a key role in selecting a candidate for surgery. “With some migraines, there are nerves coming out from either the forehead or the back of the head, and they get caught up or under pressure for some reason. We have identified that if you treat the compression, then you can treat the migraines.”
In 2010, the U.S. Food and Drug Administration (FDA) approved the use of Botox injections to treat chronic migraine headaches in adults. For treating migraines, Botox is injected around the muscle fibers that are involved in compressing the nerve. These compression sites are the cause of the sometimes debilitating pain common with these severe headaches. Botox enters the muscle and acts at the nerve-muscle junction to temporarily paralyze the muscle.
The effect wears off in a few months. But while the muscle is relaxed, it causes less compression of the nerves leading to less headaches. Migraine attacks can be accompanied by one or more of the following: visual disturbances; nausea; vomiting; dizziness; extreme sensitivity to sound, light, touch and smell; and tingling or numbness in the extremities or face.
Allan Herskowitz, M.D. , a neurologist affiliated with Baptist Health South Florida, was an investigator in drug maker Allergen’s Botox trials for migraine sufferers. If his patients are unresponsive to other medications, he recommends Botox injections.
However, surgery to relieve nerve compression is more likely to provide permanent relief for those with certain chronic migraines, which can last between four and 72 hours.
“If you’re careful about the selection of the patients who have these very specific trigger points, and determine their response to Botox and their response to anesthetic blocks, you can then go there and free the nerve and release it (with surgery), and they get much better,” says Dr. Medina.