Botox works primarily by relaxing muscles. In some people with chronic headaches, the nerves responsible for the pain that they feel are pinched by spastic muscles in the neck, temple or forehead. Injection of Botox into the muscle fibers around where the nerves are pinched may produce pain relief by relaxing those specific muscle fibers and reducing pressure on the nerve. However, the doses of Botox used and the injection technique are critical to achieving the desired result. Many patients have had Botox administered over numerous injection points (e.g. >30 injections) using relatively low doses at each injection site.
Often, many of these injection sites don't correspond to the location of a pinched nerve within the muscle being relaxed by the Botox. While this technique may be successful some of the time, I have found much greater success and more accuracy by targeting points where nerves are known to pass through spastic muscles with slightly higher doses of Botox. By targeting specific areas of muscle known to be potential nerve compression sites, the overall dose of Botox and number of injections can be minimized. This technique not only reduces overall discomfort, but can keep costs to a minimum while still optimizing the potential benefits. Stated another way, the effectiveness of this approach is often much higher because the spastic muscle fibers immediately around a nerve are more relaxed and other muscle areas that don't have a nerve around them are left alone.
The take-home message is that Botox must be used with appropriate dosing and appropriate injection techniques in order to achieve the desired result. If these parameters are not in place, a negative result may occur, but may not mean that the Botox was ineffective.
To find out more about Botox and how it may help your migraines, please visit http://peledmigrainesurgery.com or call us at (415)751-0583 to schedule a formal consultation.