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About This Project


Cost per treatment will be determined upon consultation with Dr.Mia.


There has been increasing literature that documents the efficacy of Botulinum Toxin A (eg: Botox® and Dysport®) for the treatment of variety of pain states including migraine and tension type headaches. Even though Botulinum Toxin A is most well-known for causing muscle relaxation by preventing the release of acetylcholine from nerve endings resulting in wrinkle reduction and resolution of muscle spasticity (blepharospasm) it also reduces the release of a variety of pain neuropeptides as well as blocking the feedback loop transmission of pain sensation.


For tension type headaches where persistently chronic muscle contraction contributes to the headache, a partial relaxation of the muscle in the region of the pain does much to alleviate the headache.


Tension headaches triggered by jaw clenching are also effectively relieved and prevented by using Botulinum Toxin A.  Where headaches and muscular tension in the upper back and neck are caused by muscular trigger points, the entire muscle does not need to be relaxed as this would come with considerable stability and balance effects, Only the precise trigger points require injection and relaxation.


Please note that Botulinum Toxin A is NOT effective for severe stabbing pain on the cheek region or next to the eye.


Not all headaches respond equally well to Botulinum Toxin A


Certain migraine headache types respond better than others. For those whose headaches are described as imploding (vise-like, squeezing, crushing etc.) have a much higher response rate to the Botulinum Toxin A injections, 80% more than those headaches described as exploding in nature. Headaches due to muscle spasms (especially in the back and neck region) respond well to Botulinum Toxin A too as well as most types of tension headaches.


However, headaches in certain areas do NOT respond well to Botulinum Toxin A including top of the head, cheeks, between they eyes and immediately behind the ear.


Where and how are the injections performed?


Generally speaking, the injections are performed not only in the distribution of ones headaches on one side, but also on the opposite side even if there is no pain (fixed site strategy). Why? Experience has shown that injecting only on the one side where the headaches are located will result in the appearance of migraine headaches on the opposite side. Injecting both sides prevents the switch from occurring.


There are 4 general regions that are injected:


  1. Glabellum(right above and between the eyebrows)
  2. Forehead
  3. Temples
  4. Upper Neck
  5. Masseter muscle (primary source of jaw clenching and joint pain)
  6. Temporalis (side of the head)
  7. Back of the head



Each region requires anywhere from 4-5 injections on average to as many as 10 injections with each injection containing 1 – 5 units of Botulinum Toxin A. Most patients require injections in more than one region.


After injecting, there is a SLOW reduction in the severity and frequency of migraine headache attacks resulting in decreased need for medications (if at all) over time. As such, it may be up to 2 months before the benefit of Botulinum Toxin A may be realized by the patient.


Repeat injections are required every 3-6 months to maintain the benefits as Botulinum Toxin A wears off by then. Although maximum benefits occur when used prophylactically (treatments to prevent future attacks), it can also be used in the acute setting, though not as successfully.



Who qualifies for Botulinum Toxin A injections?


Contraindications, you are NOT a candidate if you suffer from:


  • Neuromuscular Disorders (ie. Myasthenia Gravis)
  • Myopathic Disorders (ie. Amyotrophic lateral sclerosis)
  • Pregnant




Disclaimer: This page is not intended to advertise any Botulinum Toxin Type A treatments or brands and is purely for educational purposes.