We’ve all heard of Botox, but what exactly is it? Botox is a botulinum toxin, which is made from the bacterium Clostridium botulinum. It’s used for cosmetic purposes, but it can also be used to treat muscle spasms and migraines. The most common way to use Botox for migraines is by injecting it into the forehead. This helps to relax the muscles that cause migraines, so you won’t get them as often. It’s also used in other areas of the face, like around your eyes and mouth, to help with chronic headaches caused by facial muscles contracting too much.
Botox isn’t just for women—men can get it too! If you’ve been suffering from severe migraines or other issues due to muscle contractions then this may be something worth looking into!
Read on to learn more about What To Expect After Getting Botox For Migraines, Brow Lift Recovery Headache and Endoscopic Brow Lift Complications
What To Expect After Getting Botox For Migraines
Can any physician inject Botox for migraine?
Injecting Botox for migraine is not a difficult procedure, but it has to be done by a health care provider with proper training and experience, according to a specific protocol called PREEMPT. When you choose an injector, make sure that the proper protocol is followed, and adapted to your needs. You may use the mychronicmigraine.ca website where you will find a research locator for trained injectors. mychronicmigraine.ca
How are the injections given?
- The procedure takes 10 to 15 minutes.
- The patient may be lying down or sitting.
- There is a precise protocol that the doctor will follow in which 31-39 small volume injections will be given above the eyes, on the forehead, temples, back of the head, top of the neck, and the top of the trapezius.
- Extra injections can be given to target the most painful zones in a safe manner.
Here is a YouTube video with Dr Blumenfeld, top expert in Botox injections. This is a teaching video so there are a lot of details on where to inject. In real life the injections go much faster.
Watch this video.
Are the injections painful?
The needles used for Botox injections are very small and a skilled injector will do them fast enough, but needling is never agreeable.
If you have allodynia related to your chronic migraine, or if you are in the midst of an attack, injections can be more painful. Controlling your breathing is a good way to decrease the pain (See this post), especially if you are very nervous. If Botox is effective for you, the likely scenario is that the injections will be easier to tolerate over time.
Are there things I cannot do on the day of the injections?
Always discuss this with your provider as opinions and recommendations may differ slightly.
Many patients receiving Botox just attend the appointment and go on with their normal day.
The following recommendations are often seen in the clinic
- Do not wear a tight helmet or cask after the injections, it may push the Botox down your forehead and lead to cosmetic side effects.
- Do not dye your hair for 48 after the injections, as there have been multiple injections and applying an irritant chemical is not recommended.
- For certain patients, Botox can lead to a soreness due to the needling. It may be wise to avoid exercise and plan for some rest on the day of the injections.
Can I treat my migraine attack on the day of the injection?
Yes, you can use your acute medications as usual. Botox is injected locally and does not interact with medications.
When should I feel the results?
The effect of Botox is not felt immediately after the injections. It takes 7 to 10 days on average. The protein takes time to be transported to the zone where it becomes active. An increase in headaches and neck pain is sometimes seen during the first week after the injections. The effect from the previous treatment has worn off and the new treatment did not kick yet. Discuss this with your physicians to find solutions.
What could I expect as an improvement?
The goal of using Botox is to decrease your migraine frequency (responses do vary from one person to the other). Overall 50% of people who try Botox report a positive response.
Some other signs of response can be noted
- Decrease in intensity
- Better response to acute medications
- Better tolerance to triggers
- Less neck pain
- Less associated symptoms (for example nausea)
What is the wearing off phenomenon?
The duration of the Botox effect is usually 10-12 weeks. Some patients experience an increase in their migraine symptoms prior to their next injections. We call this the wearing off. If this is an issue, discuss with your injector. On the reverse, patients who respond very well to Botox may space their treatments every four months without a recurrence of symptoms.
Brow Lift Recovery Headache
“Beauty is pain,” as the saying goes — but modern cosmetics experts are proving that beauty can relieve pain rather than causing it. Surgeons have found that brow lifts can alleviate migraines, thanks to a few key elements of the surgery. Migraine headaches affect millions of Americans each year, according to the Migraine Research Foundation, and up to 90% of migraine sufferers experience pain severe enough to affect normal functions like driving, working or conversing. In addition, migraines are a chronic illness; that is, they don’t simply strike once fleetingly, but those who struggle with migraines experience them on a recurring basis and even for days at a time. There is also no known cure for migraine headaches. While there are some preventive measures as well as medications that can help manage the pain of a migraine flare-up, many people struggle to find a solution to keep their headaches at bay.
WHAT IS BROW LIFT SURGERY?
Brow lifts, sometimes called forehead lifts or upper facelifts, focus on diminishing the appearance of wrinkles on the forehead and around the eyes. These surgeries can address horizontal forehead lines, worry lines between the brows and crow’s feet. They are also commonly combined with eyelid surgery, or blepharoplasty, to correct sagging or drooping eyelids. Depending on the extent of your lines and wrinkles, your surgeon can perform brow lift surgery using one of three techniques: an endoscopic brow lift, a temporal brow lift or a coronal brow lift.
Endoscopic brow lifts have become increasingly popular in recent years because they are the least invasive option. Your surgeon uses small incisions through which they insert a thin, flexible tool with a small camera attached — they can view and manipulate the tissues underlying the skin of your brow without lifting the skin completely.
Temporal brow lifts involve slightly larger incisions than endoscopic lifts, positioned at the edges of the temples. This type of lift is the current industry standard for clients who require more work than an endoscopic lift can accomplish, and is usually the type of brow lift performed when a client is interested in an eyelid surgery as well.
Coronal brow lifts are the most invasive, using an incision that spans the full length of the brow from temple to temple along the hairline. This technique is somewhat outmoded and is currently only used in special cases.
No matter which type of brow lift is right for you, there is one distinguishing factor — unlike full facelifts, which often focus on removing stretched or excess skin causing an aged appearance, brow lifts focus on facial muscles. The main cause of forehead wrinkles is overworked facial muscles; when you make a certain facial expression particularly often, your muscles will become somewhat stuck in their tensed position, leaving behind the furrows or crinkles of a worried look or squint. During a brow lift, your surgeon removes and repositions some of your brow muscles to release this tension and smooth your brow to a more youthful, relaxed position.
UNDERSTANDING MIGRAINES
Migraines aren’t like the headaches you get when you’re tired or dehydrated. They are characterized by intense, throbbing pain that often results in nausea; sensitivity to sounds, smells and light; dizziness and even temporary sight impairment. While the pulsing pain initially led doctors to believe that migraines were caused by dysfunctional blood vessels, today’s understanding is that migraines are primarily neurological. The sensory effects of migraine attacks suggest that the headaches stem from the brain and nerves, and indeed, the most common and often effective medications for migraines treat the headaches using this principle.
Brain scans of patients experiencing migraines show a burst of activity in parts of the brainstem, an area known for processing mood and pain. In addition, a network of neurons responsible for transmitting pain around the eyes, teeth, forehead and sinuses are particularly active during a migraine. Scientists also believe that this particular network of nerves releases inflammatory chemicals as a response to specific stimuli, which contributes to the throbbing and puts even more sensory pressure around areas already sensitive from a migraine.
HOW A BROW LIFT CAN HELP
The nerves associated with migraines are located in the same areas as the muscles that cause forehead wrinkles. The added tension in the forehead not only makes migraine pressure worse but can even start to pinch some of the facial nerves and trigger migraines more frequently. When your surgeon uses a brow lift to release or remove these tensed muscles and open up more space in the tissues of the forehead, the nerves in the area are also freed from constriction and are less likely to cause shooting migraine pain.
Research also shows that minor muscle tension in the brow can cause non-migraine headaches or generalized forehead and temple pain, only serving to worsen the symptoms of migraines. Restoring relaxation to your upper face with a brow lift can go a long way toward relieving that daily dull ache as well as the debilitating discomfort of a migraine. The brow lift’s effectiveness at smoothing unwanted lines and wrinkles combined with its tension-relief benefits gives this cosmetic surgery the ability to improve your life in more ways than one — the confidence of a reflection you love and the relief of reduced head pain and tension.
Despite the apparent benefits, opinions are mixed amongst plastic surgeons, as well as The American Board of Plastic Surgery. For those reasons, we do not perform brow lifts to help treat migraines, but your primary physician can provide you with more comprehensive information about if this procedure has the potential to help you.
Endoscopic Brow Lift Complications
A brow lift is usually performed by a plastic surgeon.
A brow lift is an aesthetic surgical procedure to correct the loss of soft tissue elasticity in the upper third of the face. Excess sagging skin around the forehead causing drooping (ptosis) of the brows and wrinkling of the forehead is removed by repositioning the underlying muscle and tissue. It creates a more refreshed, youthful appearance in the upper third area of the face. It can also be combined with a facelift. A brow lift is usually performed by a plastic surgeon.
Endoscopy is the insertion through a surgical incision of a flexible tube with a lighted camera and surgical instruments. The endoscope is now used in a variety of reconstructive and cosmetic surgical procedures. Endoscopic brow lift surgery has gained widespread acceptance, is minimally invasive, and heals faster than traditional brow lift surgery.
Why do people seek endoscopic brow lift surgery?
Aesthetically, the face is divided into three equal parts, of which the forehead (from the top of the eyebrow to the anterior hairline) occupies the upper third. In males this area averages 7 cm and in females it averages 5 cm.
The male eyebrow is less arched than the female eyebrow. The top of the eyebrow lies approximately 2.5 cm from the mid pupil. With aging, these parameters may shift. A lesser distance denotes eyebrow drooping (ptosis).
Loss of forehead skin elasticity from genetics, sun damage, and gravity causes eyebrow drooping, with resultant upper eyelid drooping and dissatisfaction with the appearance.
Aging causes depletion of the subcutaneous fat. This leads to forehead wrinkling, the direction of which depends upon the underlying muscle.
Why is endoscopic brow lift surgery done?
- Aged appearance: Patients may worry they have a tired, surprised, worried, or an annoyed look, appearing older than their actual age
- Eyebrow drooping: Patients may feel an uncomfortable weight of tissue on their eyes
- Forehead wrinkling
- Eyebrow elevation
- Improve eyebrow symmetry
- Change eyebrow shape
- Decrease the function of muscles causing brow wrinkling
When should endoscopic brow lift surgery be avoided?
Endoscopic brow lift surgery should be avoided with:
- Conditions causing dry eyes
- Excessive brow elevation after upper eyelid surgery
- A tendency for keloids or thick scarring
- Psychological instability
- Unrealistic cosmetic expectations
- Poor general health and systemic conditions
What happens during the endoscopic brow lift procedure?
Before the procedure
- Routine blood and radiological investigations will be done.
- Patients may be advised to shampoo their hair with antibacterial soap/shampoo the night before or morning of surgery.
- Hair does not need to be shaved.
During the procedure
- An endoscopic brow lift is performed under general anesthesia or with intravenous (IV) sedation and local anesthesia.
- Multiple small incisions are made just behind the hairline (most surgeons make 3- to 5-cm incisions), through which the endoscope and instruments are inserted.
- Brow tissue is gently released and elevated.
- Excess tissue is removed.
- The muscles are elevated, pulled up and anchored to the bone using anchors made of titanium which look like small screws of 2 mm width. They may be temporary or permanent and do not cause permanent damage.
- The incisions are sutured and dressed.
- A small surgical drain may be inserted — a clear tube is inserted through a small incision below the main incision.
After the procedure
- Post-operative pain can be managed with painkillers.
- Antibiotics may be necessary.
- Patients are advised to rest with their head elevated for two weeks.
- Patients are usually discharged the same day or 24 hours after surgery.
- The drain may be removed after 24 hours.
- The dressing may be removed after 48 hours.
- Patients can shower and wash their hair after 48 hours, using mild shampoos prescribed by the surgeon.
- The surgeon may prescribe medicated ointments to apply to the wounds.
- Patients should not use any hair products for at least seven days.
- Depending on the type of suture used, the surg