A huge trend in headache treatment these last few years has been the use of BoTox. However, while this helps symptoms, we’ve observed it’s steadily making some patients much worse. Why? Read more for my take on botox for headache reviews.
BoTox is made from a natural toxin that poisons the connection between the nerve and the muscle and in large doses causes paralysis. In smaller doses, it just weakens this connection and relaxes the muscle. About 10 years ago the company that made the drug began to hear that it was being used to successfully treat headaches by injecting it into the head and neck muscles. This lead to a successful clinical trial and an FDA approval for this indication. Since then we’ve seen many patients with headaches originating from their upper necks who have been treated with BoTox. The good news is that for 2-3 months at a time their headaches are better, the bad news is that over time they tend to get worse and worse. Why?
We used to believe that most headaches were caused by problems in the brain like too much blood flow. However, over the last 10-15 years, research continues to implicate the neck as a major player in causing many headaches. While pain from the upper neck joints can lead to headaches, this simplistic approach is complicated by the fact that many patients after neck trauma also have atrophied upper neck muscles. Since these muscles are critical to stabilize the neck and protect the joints, nerves, ligaments, and discs, the body has an imperfect back up system if these should go off-line. It begins to use the big muscles like the trapezius, neck extensors, and SCMs to substitute and provide stability. The problem with this back up system is that these muscles weren’t designed to do this, so if they are needed for long periods, other problems begin to happen. These overworked big muscles become painful and because a few nerves that can cause headaches themselves snake past these tight muscles, this chronic muscle tightness can cause more headaches by pissing off these nerves. 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 and this 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 and that BoTox harms the muscles. Let’s explore that a bit more.
We now have good evidence that BoTox damages muscles long-term. For example, in one recent study of 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, Botox muscle injections worsened the ability of the muscle to provide feedback to the brain about it’s length by damaging the embedded sensors in the muscle. Yet another study showed that these nasty changes were happening at the genetic level. Do muscles fully recover once you stop the Botox injections? One 2013 study 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. Finally a new animal study showed that not only did BoTox damage the muscle attachment to bone, but it also reduced the surrounding bone density increasing fracture risk.
The upshot? 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 we see whose headaches eventually spiral out of control and that 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 the superficial symptoms like tight muscles!