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Botox for Migraines

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  • Indications

Classic migraines often cause auras, photophobia, unilateral foci, nausea, and pounding headaches. Botox may reduce the frequency or severity of headaches. Botulinum tox may also be used to treat recurrent tension headaches in the frontal and occipital regions.

  • Anatomic Considerations

If the patient has "trigger points" for her headaches, the site of the trigger area may be injected. The glabella, forehead, lateral brow, temporalis muscle and upper portion of the trapezius mus­cle as it enters into the occiput are the most common trigger areas. Injection of a trigger area can relieve classic or common migraines and tension headaches.

  • Injection Technique

Topical anesthesia is not neces­sary in most cases. In addition, Botox injections of the temporalis muscle may be performed.

For the posterior type headaches, trig­ger points are identified by digital pressure to the back of the neck near the origin of the trapezius muscle. A 1-inch needle is then directed into the muscle through the skin, deep toward the bone, and Botox is injected into the muscle. Typically 5 to 10 BU should be injected into this trigger area and massaged into the muscle after injection.

  • Pearls of Injection

Some patients experience immediate relief reduces the number of painful days in a percentage of migraine suffer­ers. Results can last 3 to 6 months and can be profound. In some patients there are no noticeable re­sults.

Fig. Trigger points identified by the patient are injected with Botox. These may include the trapezius, occipitofrontalis, and temporalis muscles.

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