Botulinum Toxin for Pain Management


Botulinum toxin Type A (Botox A) is a natural, biological toxin derived from live bacteria, it is not a chemically synthesized drug. They are structurally more complex than drugs and have higher variability. Botox A works at the neuromuscular junction in very small doses by inhibiting the release of neurochemical acetylcholine. This toxin action is reversible and can last 2 to 6 months in the human body.

Current FDA approved indications for Botox A include writer’s cramp, spascticity, Frey’s syndrome, hyperhidrosis,anismus, detrusor-spincter dysnergia, focal Limb dystonias and achalasia.


Many other conditions that benefit from Botox A include essential type tremor, chronic neck and back pain, migraine and tension type headache, TMJ dysfunction, stuttering, myofascial pain syndrome, stiff person’s syndrome, sialorrhea.


Of special interest is the possibility of using Botox A treatment in combination with all the other advance therapeutic modalities available at Grace Life Medical Center. Before Botox was used to treat migraine, other modalities have been used with success for many years to help over 80% of the migraine sufferers. After a careful history and examination, Dr. Wong prefer first to use other methods of less cost and side effects (No paralyzed muscles) to alleviate the pain. In refractory cases, selected muscles of higher importance (e.g. corrugator supercilii muscle, Spenius capitus insertion) in producing pain can be then injected with Botox A.


Botox A may be useful for transformed migraine, chronic tension type headache, new daily persistent headache, hemicrania continua, rebound analgesic headache.


Those patients that might benefit more from botox A injection usually have pericranial muscle tension. They might describe pain that radiates from the back of the head (occiput) to the side of the head (temple) and across the front eyes. In severe cases, the headache may also present with bright lights, tunnel vision, and spasm of the muscles with a throbbing sensation.


The clinical data presented at the 45th Annual Scientific Meeting of the American Headache Society (AHS) in June 2003 by Dr. Blumenfeld found that Botulinum toxin type A is an effective preventative therapy for headache and Migraine pain in chronic sufferers.


In the study, patients were treated every three months, with a minimum of 2 treatments and a maximum of 5 treatments.

  • 80% (217) said their head pain episodes were less frequent, less intense or both.
  • 60.5% (164) reported good to excellent pain relief.
  • 19.5% (53) reported some pain relief.
  • 20% (54) reported no relief.

side effects reported are few and minor

  • eyebrow drooping (1%)
  • neck muscle weakness (1%)
  • other effects such as flu-like symptoms or head pain (2%).


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