A chronic tension-type headache is not as debilitating as a migraine but can still reduce one’s quality of life when it recurs and does not respond to medication. Symptoms of a tension headache include steady pain on both sides of your head, intense pressure around your head, and sometimes pain in the lower back of the head. People who suffer from treatment-resistant tension headaches can now find pain relief with Botox for tension headaches.
Tension headaches are believed to emerge from a combination of factors, such as genetics, stress, and possibly undetected medical issues. In addition, doctors believe that continuous muscle contractions in the neck and head contribute significantly to the persistence of tension headaches. Botox not only prevents muscles from contracting but may also help reduce the frequency of tension headaches.
Repeated contractions of facial muscles (smiling, frowning, laughing) is one of the primary causes of permanent fine lines and wrinkles. Nerves embedded in muscles must be stimulated by a chemical called acetylcholine to induce muscle contractions. Decades ago, researchers discovered that preventing the release of acetylcholine stops muscle cells from contracting. The substance used to block the release of acetylcholine and “freeze” muscles is now known as Botox.
Approved in 1991 by the U.S FDA for medical and cosmetic purposes, OnabotulinumtoxinA (Botox) is a weakened derivative of the Botulinum toxin that causes botulism, a severe type of food poisoning. Released by the bacterium C. botulinum (clostridium botulinum), Botulinum toxin type A is the main ingredient in cosmetic injectables like Botox and Dysport. Neurotoxins like Botox reduce the appearance of wrinkles and brow furrows by preventing acetylcholine from activating muscle nerve endings.
The mechanism behind Botox’s ability to reduce tension headaches involves two actions: preventing the release of acetylcholine to stop muscle spasms and contractions and stopping a chemical called substance P from irritating the trigeminal nerves.
Substance P is a neurotransmitter found mostly in the spinal cord, gastrointestinal system, and brain. It performs various functions related to inflammation, wound healing, and the formation of blood cells. In the context of tension and migraine headaches, substance P increases pain sensitivity by promoting the production of cytokines (proteins associated with inflammation).
The trigeminal nerve is one of 12 cranial nerves that mediate facial sensations and muscle movements. Originating in the brainstem, it is also the largest cranial nerve that stimulates muscles essential for chewing. The effectiveness of Botox for tension headaches is attributed to the ability of the botulinum toxin to freeze muscle contractions while preventing substance P from flooding face and head muscles with cytokines. Botox also seems to disrupt the transmission of pain signals from the brain to nerves extending from the spinal cord.
To alleviate tension headache pain, doctors give Botox injections around the temples, forehead, and lower back of the head and neck. Since headache pain typically originates from muscles continuously contracting in these areas, physicians often refer to them as “trigger points.”
When administered by qualified, experienced Botox providers, botulinum toxin injections are safe and effective for treating chronic tension headaches. Side effects last about one to two days and mostly involve injection site swelling and soreness. Other common side effects of Botox for tension headaches include:
Slight eyelid drooping (eyelid ptosis)
Clinical trials indicate that most side effects are mild and almost never cause people to stop treatment. In rare cases, some people may have an allergic reaction to Botox that causes skin rash, itching, difficulty swallowing, and extreme muscle weakness. When someone develops symptoms of an allergic reaction to Botox, their immune system makes antibodies designed to neutralize the effects of Botox. Blood tests can detect the presence of these allergen antibodies to determine if it actually is an allergic reaction to Botox.
Tension headaches can be mistaken for episodic migraines when the pain is severe and unresponsive to ibuprofen or acetaminophen. Although both tension headaches and mild migraines cause steady head pain, migraines are defined by a constellation of symptoms, including nausea, vomiting, visual auras, and pain on one side of the head only.
Now that healthcare providers understand tension headaches and chronic migraine headaches involve abnormal muscle contractions, doctors are providing Botox to people who experience frequent tension headaches that cannot be relieved by OTC medication. However, before recommending Botox to patients with tension headaches, physicians may suggest trying one of several migraine treatment medications commonly prescribed. These include:
Beta-blockers for lowering blood pressure
Calcitonin gene-related peptide (CGRP) antagonists that block the CGRP protein implicated in severe headaches
The problem with taking prescription drugs for tension headaches or migraines is the potential for medication-overuse headaches (MOHs). Research indicates that people with a history of tension headaches or migraines are at high risk for MOH. However, MOH has not been documented in individuals who do not have a history of tension headaches or migraines but take pain medication for arthritis and other conditions.
Everybody gets headaches occasionally, but it is not normal to experience recurring headaches or the type of headache that stops your daily routine. The most common reasons for primary headaches involve lifestyle factors such as physical and/or emotional stress, skipping meals, eating processed food containing nitrates, drinking red wine, and poor sleep quality. Secondary headaches are caused by infections or diseases that stimulate one or more of the 12 cranial nerves. Examples of secondary headaches include:
If a chronic daily headache or increased headache frequency interferes with your daily life and preventative treatments or pain relievers have not worked to reduce the severity of headaches, you should consider Botox for tension headaches. Your doctor or healthcare provider may want you to visit a neurologist who specializes in diagnosing the causes of primary and secondary headaches. Various diagnostic techniques are routinely given to identify the reasons behind chronic head pain, such as:
MRIs (can detect abnormal brain architecture that may be causing headaches)
Erythrocyte sedimentation rate (blood test for detecting systemic inflammation)
Digital subtraction angiography (provides contrast images of the brain’s blood vessels)
Spinal tap (detects fungal or bacterial infections that are often responsible for headaches)
Good candidates for Botox headache relief are over 18 years old and have experienced 15 or more tension headache days or migraines per month for at least three months, consecutively.
Most people need two treatments before they notice the benefits of Botox for head pain. However, some patients may experience relief immediately, depending on the severity of tension headaches, their overall health, and other factors. Generally, if a person has not responded well to three courses of Botox injections, they should assume Botox is not the right headache treatment for them. However, the majority of our patients seeking headache relief with Botox can expect the results to last up to six months.
In addition to reducing the frequency and severity of tension headaches, Botox provides additional benefits. You can drive yourself home after Botox treatment (no anesthesia is needed), injections take little time to be administered, injections are relatively painless, and side effects are negligible compared to medication side effects.
Your face is controlled by dozens of muscles that contract to make a wide variety of facial expressions. A trained Botox professional is familiar with facial anatomy and knows exactly where all muscles and other soft tissues are located. Inexperienced Botox providers may not know about facial muscles, their locations, and which movements they regulate. Consequently, injecting Botox into the wrong spot could lead to problems involving muscle activity, muscle strength, and ineffective results.
At Virginia Surgical Arts, you’ll be in the hands of a highly skilled and knowledgeable Botox provider who understands how neck and head muscles work and how targeting certain facial areas can significantly improve the results of Botox for tension headaches. If you suffer from chronic tension headaches or migraines and have not found relief from standard treatments, please contact Virginia Surgical Arts at (757) 430-7690 or fill out our online contact form to schedule a consultation appointment. We can help you regain your quality of life and alleviate debilitating head pain that prevents you from doing the things you love to do.