Indications

Symptoms of classic migraines may include auras, photophobia, unilateral foci, nausea, and pounding headaches. BoNTA has been used successfully in some patients to reduce the frequency or severity of their headaches. Similarly, BoNTA may be used to treat patients with recurrent tension headaches in the frontal and occipital regions. Botox is the only BoNTA currently FDA approved to treat chronic migraines.

Anatomic Considerations

Individual patients may be able to determine “trigger points” for their headaches. If feasible, try to inject directly into the site of the trigger area. Most often, the glabella, forehead, and lateral brow as well as the temporalis muscle and upper portion of the trapezius muscle as it enters the occiput are the most common areas in which injection can relieve classic or common migraines and tension headaches.

Injection Technique

Topical anesthesia may be used, and ice may be applied, though neither is necessary in most cases. Injection techniques as described herein for the treatment of the glabella, forehead, and lateral brow-lift are used for migraine headache as well. In addition, BoNTA injections of the temporalis muscle may be performed on the offending side.

For the posterior type headaches, trigger points are identified by digital pressure to the back of the neck near the origin of the trapezius muscle. A 1-inch (2.5-cm) needle is then directed into the muscle through the skin, deep toward the bone, and BoNTA is injected into the muscle. Typically 5 to 10 BU (or 15 to 30 DU) is injected into this trigger area and massaged into the muscle after injection.