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SIU Migraine Clinic

History of Botox® in Migraine Headache Management

Dr. Guyuron, the pioneer and leading researcher of migraine surgery, as well as other plastic surgeons, noticed patients who underwent Botox® injections to reduce lines and wrinkles on the face also enjoyed the added benefit of having fewer migraine headaches. Many cosmetic patients who also suffered from migraine headaches who had brow lifts actually reported relief from migraine pain. This discovery led to the development of surgical treatment for patients who had not responded to traditional treatment of migraines.

During the process of surgically treating migraines, Botox® injections are used to determine which muscles in the forehead, back of the head, or temples (frontal, occipital, and temporal regions) may be causing the migraines. Botox® injections temporarily weaken the muscles that may be points of compression, irritation, or pressure on adjacent nerves and nerve bundles that then cause the migraine pain. An initial step in the migraine surgery evaluation is the determination of the primary migraine trigger zone and any additional secondary trigger zones. Determination of the migraine zone is based on review of a patient's medical history and 4 week migraine headache diary, physical exam and response to Botox®.

Botox® as diagnostic test

Botox® is also used as a diagnostic test to determine what trigger point(s) is causing the migraine and to determine if a patient with chronic, intractable migraine headaches will benefit from a more permanent surgical solution. The surgical technique -- performed by only a handful of plastic surgeons in the U.S. -- includes using Botox® to pinpoint which of several specific muscles in the forehead, back of the head or temple areas may be serving as trigger points to compress, irritate or entrap nerves that could be causing the migraine. Because Botox® temporarily inhibits muscle contraction, usually for about three months, it can be used as a trial test to see if a patient's migraine headaches go away or become less intense following a Botox® injection.

If a Botox® treatment is successful in preventing migraines or lessening their severity, then surgery to remove the triggering muscle is likely to achieve the same result, possibly permanently. Botox® treatments are used to determine if a patient will likely benefit from surgery. If a patient improves following a Botox® treatment to the trigger areas, they will likely benefit from surgery. If no benefit is seen following Botox® treatment, then it is unlikely that the patient would respond from surgery. Strict treatment algorithms and guidelines have been developed that includes administering Botox® to determine if a patient is an appropriate surgical candidate. Botox® injection is an essential component of the migraine surgery evaluation.

Plastic surgeons that perform these surgical procedures typically will only see migraine patients who have been diagnosed with recurrent migraines by a neurologist or pain management specialist and who have failed standard conservative migraine therapies.

Botox® treatment for migraine headaches

Botox® injected into the muscles of the brow, eyes, forehead, side of the head and back of the head near the neck has been found to provide migraine relief reducing both the frequency and severity of migraine attacks. Botox® has been reported to provide benefit to patients for up to six months and may cause fewer side effects than many of the standard medications used to treat migraines.

Migraine Surgery

History of migraine surgery:  Botox® to Surgery

Migraine surgery developed from the pioneering work of Dr. Bahman Guyuron, in Cleveland, Ohio. Dr. Guyuron observed that patients who had injections of Botox® for cosmetic purposes and patients who underwent brow lift surgery incidentally noted a significant reduction of their migraine headaches. In Botox® treated patients the headaches returned when the Botox® wore off. In the surgically treated patients the positive effect was permanent. Many patients achieved complete elimination of their migraine headaches following this type of cosmetic surgery.

Dr. Guyuron and his colleagues have demonstrated that 70-80% of migraine patients undergoing Botox® injections achieve a 50% improvement in frequency, severity and duration of migraines. Botox® has been shown to be an excellent predictor of migraine surgery success. A positive response to Botox® predicts a 90% success rate for migraine surgery, with 35% of surgical patients achieving complete elimination of the migraines (migraine cure) and the remaining achieving a significant permanent reduction in their migraine frequency, severity and duration.
Dr. Sommer is the first plastic surgeon to bring this beneficial surgical treatment for migraine sufferers to the Springfield area. Dr. Sommer is one of only a handful of surgeons in the United States who perform Botox® injections as a diagnostic tool to determine migraine trigger points that are amenable to surgery.

FAQ's

How did migraine surgery develop?

Migraine surgery developed from the pioneering work of Dr. Bahman Guyuron, in Cleveland, Ohio. Dr. Guyuron observed that patients who had injections of Botox® for cosmetic purposes and patients who underwent brow lift surgery incidentally noted a significant reduction of their migraine headaches. In Botox® treated patients the headaches returned when the Botox® wore off. In the surgically treated patients the positive effect was permanent. Some patients achieved complete elimination of their migraine headaches following this type of cosmetic surgery.

What is migraine surgery?

Migraine surgery is a surgery undertaken for the expressed goal of reducing or eliminating migraine headaches. The specific surgery that is performed is based on individual's specific trigger sites or migraine zone that is involved: frontal, temporal, occipital or nasal. The actual surgical technique performed is specific to the anatomical migraine zoneMigraine surgery is an option to explore after failure of traditional migraine medications and medical treatments.

Where is migraine surgery performed?

Migraine surgery is a revolutionary, but proven approach for the treatment of migraine headaches and has provided migraine relief for chronic migraine sufferers for the past decade. Dr. Sommer is the first plastic surgeon to bring this beneficial surgical treatment to the Springfield area. Dr. Sommer is one of a handful of surgeons in the United States who perform Botox®  injections as a diagnostic tool to determine migraine trigger points that are amenable to surgery.
The SIU Healthcare Migraine Surgery Clinic is pleased to offer migraine surgery at two convenient locations in the Springfield area: Memorial Medical Center and St. John’s Hospital.

Is migraine surgery covered by insurance?

Many insurance companies now cover most of the cost of the Botox® injections as it is an FDA approved treatment for migraine headaches. Many insurance companies now also cover most of the costs of several of the migraine decompression surgeries.  

How does Botox® work to reduce or eliminate migraine headaches?

Botox® results in temporary weakening of the muscles that compress or impinge on nerves in areas which may trigger migraines. Low doses of Botox® are injected in tiny doses directly into the muscle area that Dr. Sommer has identified as the trigger zone for your migraine (the frontal, temporal or occipital area). By blocking the release of a chemical that causes these muscles to contract, Botox® allows them to relax. This takes the pressure off the irritated nerves, making the migraine patient more resistant to triggering factors which raises the threshold for developing a migraine attack.

Is Botox® safe for treating migraine headaches?

Botox® has been used for over 25 years and is a safe and effective treatment in experienced hands. Botox® Cosmetic has also been shown to be effective for treatment of migraine headaches, excessive underarm sweating, certain muscular spasm disorder, in addition for cosmetic purposes. Botox is FDA approved for the treatment of migraine headaches.

What is a Botox treatment like?

Botox® injection for migraines is a quick and minimally invasive procedure consisting of a few tiny injections. Dr. Sommer will identify your particular migraine trigger zone based on review of your medical records, migraine headache diary and physical exam. No anesthesia is required. The Botox® is precisely injected into the specific area to be treated through a tiny needle. The actual Botox® injection treatment lasts just one to three minutes depending on the number of areas being treated. There is no downtime afterward and discomfort is minimal and brief. Many patients return to work the same day. You should not rub the area that has been injected for 72 hours.

Who should perform Botox injections for migraines?

Quite simply, we believe board certified Plastic Surgeons who have had additional training on the use of Botox® for migraines, are the ideal medical professionals to treat patients with Botox®. Plastic Surgeons have the most extensive knowledge of the anatomy and physiology of all the facial muscles involved in facial expression and therefore are the most qualified to perform Botox® injections. In addition, board certified plastic surgeons have been awarded the highest qualifications by the American Board of Plastic Surgery through extensive evaluations and residency requirements. Dr. Sommer is a board certified Plastic Surgeon who has had detailed training in facial anatomy and nerve distribution, extensive experience with Botox® and has completed additional training on the use of Botox specifically for migraine patients.

Why do some patients treated with Botox® for cosmetic purposes look unnatural?

We have all seen photos of celebrities who have been treated with Botox® and have unnatural appearances ranging from brows lifted too high to too low, or a frozen face appearance. The effect of Botox® Cosmetic used in the facial areas (frontal or temporal), whether for cosmetic or migraine purposes, is primarily dependent on three important factors:

  • The qualification and experience of the person providing the treatment.
  • The dose of Botox® that is injected – the amount of muscle contraction weakness depends on the amount of Botox® that is administered into the particular treatment area.
  • The dose has been injected correctly into the appropriate treatment area to achieve the desired effect

The goal of our physicians when performing Botox® Cosmetic injections for cosmetic purposes is to provide the most natural-appearing result as possible to meet our individual patient's goals in a realistic manner. These same goals are adhered to whether the patient is having Botox® injections purely for cosmetic reasons or whether the patient is having Botox® injections in the frontal or temporal area for migraine relief and migraine diagnostic purposes.
With Dr. Sommer's treatment approach for cosmetic or migraine patients, patients are very pleased with their natural, rested, refreshed appearance. She avoids the over-treated appearance that you can get by either using too much Botox® in an area or not completely understanding the anatomy of the facial muscles and inappropriately injecting Botox® in an area that may cause an unnatural look.

Who should not undergo Botox® injections?

You should not be treated with Botox® Cosmetic if you:

  • have a skin infection at the planned injection site
  • are allergic to any of the ingredients in Botox® or Botox® Cosmetic
  • have allergies to any botulinum toxin product including Myobloc or Dysport
  • have a disease that affects your muscles and nerves (such as amyotrophic lateral sclerosis [ALS or Lou Gehrig's disease], myasthenia gravis or Lambert-Eaton syndrome)
  • had any side effect from any botulinum toxin product in the past
  • have a breathing problem, such as asthma or emphysema
  • have swallowing problems
  • have bleeding problems
  • have weakness of your forehead muscles, such as trouble raising your eyebrows
  • have drooping eyelids
  • have any other change in the way your face normally looks
  • are pregnant or plan to become pregnant. It is not known if Botox® Cosmetic can harm your unborn baby
  • are breast-feeding or plan to breast feed. It is not known if Botox® Cosmetic passes into breast milk

What is the chance that a Botox® injection will help my migraine headaches?

How many migraine sufferers will benefit from Botox® injection is a common question that we are asked. Trigger sites in the frontal, temporal and occipital areas can be identified by injections of Botox®. It has been shown that in these three areas, Botox® causes weakening of the muscles for 6 – 12 weeks resulting in over 50% improvement in frequency, severity and duration of migraines in 70-80% of patients undergoing Botox® injections. Botox® has been shown to be an excellent predictor of migraine surgery success. A positive response to Botox® predicts a 90% success rate for migraine surgery resulting in complete elimination of the migraines or a significant permanent reduction in migraine frequency, severity and duration.