Botulinum toxin (Botox®) Injections for Headaches and Movement Disorders of the Eyes and Face

Botulinum toxin, commonly referred to as Botox®, has received considerable press coverage since the FDA approved it for cosmetic use to eliminate glabellar lines, the frown wrinkles between the eyes. Yet Botox® has long served other medical purposes, and physicians at the Kellogg Eye Center have used it for over 30 years.

For example, Botox® has been effective in helping patients with disabling focal dystonias (movement disorders) that affect the eyes and face. Two such disorders are blepharospasm and hemifacial spasm. The conditions cause repeated involuntary closure of the eyelids—uncontrollable blinking that essentially blinds the patient. Not surprisingly, these chronic conditions take a significant emotional and physical toll on those affected. We are pleased to advise our patients that intermittent injections of botulinum toxin can, in most cases, provide welcome relief.

In 2010 another use for Botox®—as an effective treatment for migraine headaches, was approved by the FDA. Some 30% of the population suffers from headaches, a condition that occurs more frequently in women. For some patients headaches are both severe and occur frequently, even daily. While a number of medications can be used to treat headaches, some have side effects or are ineffective. In patients who have failed oral medications, and meet other criteria, Botox can be used to successfully treat their migraines.

The treatment for migraines consists of 31 injections, in the forehead, temples, back of the head, neck and shoulders. Side effects are uncommon and tend to be brief. The injections take from 1 to 14 days to have an effect, and last 10-12 weeks. Botulinum toxin is thought to work by either reducing muscle contraction, blocking a pain-transmitting chemical, or through a combination of these actions.  

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Reviewed by Wayne Cornblath, MD