Botox helps with migraines. Yes, we are not only about getting rid of wrinkles. I recently saw a patient who has bad migraines…The ones which keep you from functioning, which in our busy Silicon Valley lives with jobs, kids, and activities, frankly we don’t have time to lie around with an ear splitting headache. So botox has worked for her in the past, but only once, and she has had botox multiple times. So where is the trigger? Where can we knock out so her headaches are gone?
This is a study out of Ohio in my recent issue of Plastic and Reconstructive Surgery Journal. The title is “The Current Means for Detection of Migraine Headache Trigger Sites.” The author has a 15 year experience with migraine surgery and has seen 1000 patients. He is addressing the headaches with surgery.
The salient points of the article are below.
- Surgical intervention targets 4 major sites:
- Frontal trigger site. PUT YOUR FINGER ON YOUR INNER EYEBROW. This is in the glabella region, and likely why botox is so good for many migraine patients. It is addressing the corrugator muscle. He states this involves the supraorbital and supratrochelar nerves, which get irritated by the glabella muscles. Associated symptoms:
- pain starts above eyebrows
- Pain starts in the afternoon
- Strong corrugator muscle activity (deep lines between the eyebrows)
- The nerve exits are tender to the touch
- In times of active pain, the eye can be droopy (ptosis)
- stress can trigger.
- Application of cold or warm can reduce the pain.
- Pressure can stop the headache in the initial stages.
- Temporal trigger site. Here the zygomaticotemporal branch of the trigeminal nerve is compressed by the temporalis muscle and the deep fascia. PUT YOUR FINGER ON YOUR OUTER EYEBROW. There are minor sites near here which are branches of the auriculotemoral nerve. PUT YOUR FINGERS ON YOUR TEMPLE JUST ABOVE THE EAR LEVEL.
- Pain starts in the temple
- Patients wake up with pain in the morning after clenching or grinding at night
- Tender in the temporalis or masseter muscle
- Wearing of dental facets
- Rubbing or pressing on the nerve exit can stop or reduce the pain
- Warm or cold may reduce the pain
- Stress can trigger.
- Rhinogenic trigger. This is where the sinus, septum of the nose, turbinates can irritate the end branches of the trigeminal nerve. PUT YOUR FINGER ON YOUR CHEEK TO THE SIDE OF YOUR NOSE NEAR THE LOWER EYE RIM.
- Pain starts behind the eye
- Wake up with pain in morning or night
- Headache triggered by weather changes
- Rhinorrhea (runny nose) can accompany pain on affected side
- Related to nasal allergy
- Triggered by menstrual cycle
- CT scan findings: septal deviation and contact between turbinates and septum.
- The fourth major site is on the back of the head, where the upper neck meets the skull. Here the occipital nerves are irriatate by the spinalis capitis muscle. There is a minor trigger spot here lower on the neck as well.
- Pain starts at exit of greater occipital nerve from semispinalis capitis muscle
- no specific starting time
- may have a history of whiplash
- neck muscles are tight
- heavy exercise can trigger
- compression can stop pain in early stage. later the point is tender
- cold and heal may improve the pain
- stress can trigger.
- Frontal trigger site. PUT YOUR FINGER ON YOUR INNER EYEBROW. This is in the glabella region, and likely why botox is so good for many migraine patients. It is addressing the corrugator muscle. He states this involves the supraorbital and supratrochelar nerves, which get irritated by the glabella muscles. Associated symptoms:
- Surgery tries to fix these issues by releasing the nerve where it being compressed or irritated along its course. If pain is not relieved, it could be the headache starts from a different trigger site, not where the pain is.