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Using botox to treat headaches has become hugely popular in recent years. While botox treatment helps symptoms, it’s been observed to steadily make some patients much worse.

Botox is made from a natural toxin that poisons the connection between the nerve and the muscle. In large doses it causes paralysis. In smaller doses, it just weakens this connection and relaxes the muscle. About 10 years ago, the company that makes the drug began to hear that it successfully was being used to treat headaches by injecting it into the head and neck muscles. This led to a successful clinical trial and an FDA approval for this treatment. Since then many patients with headaches originating from their upper necks have been treated with botox. The good news is that for two to three months at a time the patients’ headaches lessen. The bad news is that over time the headaches tend to become worse and worse.

We used to believe that most headaches were caused by problems in the brain, like too much blood flow. Recent research implicates the neck as a major cause of many headaches. While pain from the upper neck joints can lead to headaches, this simplistic approach is complicated by the fact that the neck muscles have atrophied in many patients who have suffered neck trauma. These muscles are critical to stabilize the neck and to protect the joints, nerves, ligaments, and discs. If these muscles should weaken, the body begins to use the bigger muscles to provide stability. The problem with this back-up system is that if these muscles are needed to do this for long periods, other problems develop. The overworked big muscles become painful. A few of the nerves that can cause headaches snake past these tight muscles, so this chronic muscle tightness can cause more headaches. While injecting botox can relax these overworked muscles, it also takes the back-up stability system off-line, leaving the neck joints, nerves, ligaments, and discs unprotected. This in turn causes repetitive damage in those structures, leading to a host of new problems. In addition, while botox advocates claim that the substance is completely reversible and the muscles return to normal when the treatment is stopped, there’s mounting evidence that this isn’t really true.

We now have good evidence that botox damages muscles long-term. For example, a study reported in the April 2014 issue of Diagnostic and Interventional Imaging looked at botox injections into a hip muscle to treat sciatica. MRIs showed a big reduction in the thickness of the muscle as well as fatty atrophy (evidence that the muscle was shrinking and dying). In another study reported in the July 2014 issue of the Journal of Neuroscience Research, botox muscle injections worsened the ability of the muscle to provide feedback to the brain about its length by damaging the embedded sensors in the muscle. Yet another study published in the March 2014 issue of Muscle and Nerve showed that these nasty changes were happening at the genetic level. Do muscles fully recover once you stop the Botox injections? One study published in the July 2013 issue of the Journal of Biomechanics found that while the treated muscles could partially recover, there was permanent damage in the opposite non-injected muscle!  Why?  Because while we conceptualize the body as made up of many individual muscles, it’s actually made up of neurologic muscle units that must work together to work at all, so damaging one part of that coordinated and finely tuned system alters the neurology of the rest of the system.

Far too often, what gets offered to headache patients isn’t necessarily what’s best for them, just whatever product happened to get pushed through the gauntlet of insurance reimbursement. While botox seems to help headaches in the short run, don’t be one of the patients whose headaches eventually spiral out of control and who develop new problems caused by the fact that botox is damaging their neck stability systems. Seek out physicians who can delve deeply into the cause of the headaches, not just such superficial symptoms as tight muscles.


“Botox for Headache Reviews” first appeared as a post on the Regenexx blog.
Like all medical procedures, Regenexx procedures have a success and failure rate.
Not all patients will experience the same results.