BOTOX® for Migraine and Jaw Pain

By Deena E. Kuruvilla, MD; Brooklyn A. Bradley, BS

Do you have migraine? What about migraine *and* jaw pain? Many people believe that jaw pain is completely unrelated to migraine and headaches. However, recent research has shown that both often exist together (1). In an epidemiological study, researchers found that 53-87% of patients with migraine had jaw pain (2).

If you have both headaches and jaw pain, the first thing to do is to identify the type of headache — although migraine is the most likely cause, it is always important to rule out dangerous causes for headache such as aneurysm, temporal arteritis and several other possibilities. It is also important to check for temporomandibular joint dysfunction (TMD), a common occurrence with migraine.  After identifying the type of headache, there are many different types of therapy, including physical therapy, splint therapy, medications, myofascial trigger point injections and BOTOX®.

Botulinum neurotoxin (BoNT) is able to relax the muscle because it blocks the release of acetylcholine at the neuromuscular junction. The original neurological purpose of Botulinum toxin serotype A (BoNT/A) was for the treatment of dystonia (involuntary muscle contractions)  and blepharospasms (uncontrolled blinking or other eyelid movements) (3). However, BoNT/A is now used worldwide for the treatment of chronic migraine2. BOTOX® is now viewed as an attractive option for patients who may not respond well to mainstream medical therapy. The FDA has approved the use of BOTOX® for the treatment of chronic migraine in adults who are 18 years or older (4).

For certain patients, BOTOX® can be an extremely effective treatment for the treatment of both migraine and jaw pain. In a 2016 study, researchers found that injection of 21 units of BOTOX into the masseter and temporalis muscles significantly improved symptoms for patients (5). In a randomized controlled trial studying onabotulinumtoxinA for treatment of chronic migraine, it was reported that onabotulinumtoxinA is an effective prophylactic treatment for chronic migraine (6). The researchers also found that the treatment resulted in significant improvements compared to placebo in headache symptom measures (6). In my clinical experience, BOTOX® has been very effective for patients with migraine with or without jaw pain, especially in conjunction with other treatment strategies and lifestyle modification. As such, it’s important to consider BOTOX® if you have symptoms of headache and temporomandibular dysfunction, including below:

  • Pain or tenderness of your jaw
  • Pain in one or both of the temporomandibular joints
  • Aching pain in and around your ear
  • Difficulty chewing or pain while chewing
  • Aching facial pain
  • Locking of the joint, making it difficult to open or close your mouth

In a survey, 92% of current  BOTOX® users stated that they wished they had spoken to their doctor and started  BOTOX® treatment sooner (7). It is important to discuss this treatment with your provider to learn more about this type of therapy and the benefits it can provide for migraine and jaw pain. Overall, the goal of  BOTOX® for migraine is to reduce the frequency of the patient’s migraines. 

We look forward to helping you at the Westport Headache Institute! – Dr. K

 

References:

  1. Gonçalves, Daniela A. G., et al. “How to Investigate and Treat: Migraine in Patients with Temporomandibular Disorders.” Current Pain and Headache Reports, vol. 16, no. 4, Aug. 2012, pp. 359–64. PubMed, https://doi.org/10.1007/s11916-012-0268-9.
  2. Florencio, Lidiane Lima, et al. “Association Between Severity of Temporomandibular Disorders and the Frequency of Headache Attacks in Women With Migraine: A Cross-Sectional Study.” Journal of Manipulative and Physiological Therapeutics, vol. 40, no. 4, May 2017, pp. 250–54. ScienceDirect, https://doi.org/10.1016/j.jmpt.2017.02.006.
  3. Do, T. P., et al. “Botulinum Toxin: A Review of the Mode of Action in Migraine.” Acta Neurologica Scandinavica, vol. 137, no. 5, May 2018, pp. 442–51. PubMed, https://doi.org/10.1111/ane.12906.
  4. “Botox for Migraine.” American Migraine Foundation, https://americanmigrainefoundation.org/resource-library/botox-for-migraine/. Accessed 26 July 2022.
  5. Pihut, Malgorzata, et al. “The Efficiency of Botulinum Toxin Type A for the Treatment of Masseter Muscle Pain in Patients with Temporomandibular Joint Dysfunction and Tension-Type Headache.” The Journal of Headache and Pain, vol. 17, 2016, p. 29. PubMed, https://doi.org/10.1186/s10194-016-0621-1.
  6. Dodick, David W., et al. “OnabotulinumtoxinA for Treatment of Chronic Migraine: Pooled Results from the Double-Blind, Randomized, Placebo-Controlled Phases of the PREEMPT Clinical Program.” Headache, vol. 50, no. 6, June 2010, pp. 921–36. PubMed, https://doi.org/10.1111/j.1526-4610.2010.01678.x.
  7. BOTOX® for Chronic Migraine | Chronic Migraine Treatment. https://www.botoxchronicmigraine.com/. Accessed 26 July 2022.
Published On: July 27th, 2022