One of the newest developments in botulinum toxin treatments is that for the treatment of migraine headaches that are at the “hatband” area (that means migraine headaches that are located around the forehead, temples, above and behind the ears and at the back of the head and neck).
These migraines are mostly brought on by masticatory myalgias and associated muscular headaches caused by bruxism. Bruxism, or the grinding and clenching of teeth, occurs in approximately 15 percent of children and in as many as 96 percent of adults.
The etiology of bruxism is unclear, but the condition has been associated with stress, occlusal disorders, allergies and sleep positioning. Because of its nonspecific pathology, bruxism may be difficult to diagnose. In addition to complaints from sleep partners, signs of teeth grinding include masticatory pain or fatigue, headaches, tooth sensitivity and attrition, oral infection and temporomandibular joint disorders.
Signs of bruxism include tooth wear and mobility, as well as tender or hypertrophied masticatory muscles and joints. Children with bruxism are usually managed with observation and reassurance. Adults may be managed with stress reduction therapy, alteration of sleep positioning, drug therapy, biofeedback training, physical therapy and dental evaluation.
If significant tooth attrition, mobility or fracture occurs, dental referral is mandatory. Methocarbamol (Robaxin) and injections of botulinum toxin A have been reported to be useful in the management of bruxism.
For patients who have suffered for years from these types of sometimes debilitating headaches, botulinum toxin has offered almost immediate alleviation. Here are some comments from San Antonio patients:
- ”It is an immediate relief from these agonizing headaches that systemic migraine medications wouldn’t even touch at times,” says Dr. Vi Maievschi.
- ”After I gave birth to my first son in 2000, I suffered from horrible migraines due to hormone changes and I’m sure the new stress of being a mom. My physician in Seattle recommended trying Botox® to alleviate these migraines. Sure enough, it worked. I was able to stop the injections after about a year, but it sure helped me be a happier mom during that time by eliminating my migraines,” says Erin M. Barry.
- ”It was a life-changing experience for me being able to wake up, go throughout my day and go to bed without headaches, which in return for me means enjoying being a wife and a mom ... without missing a beat. Best of all no more medicines,” says Jade Battah.
- ”I thought I was destined to take these medicines for the rest of my life, just to get rid of these debilitating headaches. The splint my doctor prescribed along with the medications definitely helped some, but when I got the Botox® injections it was like night and day. I received the Botox® treatment twice so far, six months apart. The last treatment was three months ago. I have not taken any medications in the past eight-and-a-half months. I am amazed at how miraculous this treatment really is,” says Manuel Castro.
As many of you already know, Botox® by Allergan and DysportTM by Ipsen are two brand names for botulinum toxin A, some of the world’s most versatile medications.
Botox® is the original FDA approved neurotoxin and Dysport represents its new approved botulinum toxin type A option, first released in the United States.
These medications are being used around the world to improve the physical well-being and resulting quality of life for people who suffer from a variety of disorders.
Botulinum toxin A history
Botulinum toxin A has been FDA approved for six specific reasons:
- Strabismus (cross-eye sightedness)
- Blepharospasm (eye twitching)
- Cervical dystoria (abnormal head position and associated neck pain)
- Primary axillary hyperhydrosis (underarm sweating)
- Upper limb spasticity
- Glabellar lines reduction (lines between the eye brows)
Due to its amazing versatility, botulinum toxin A is being used off-label (for not yet FDA approved treatment) for 21 additional beneficial treatments.
This discrepancy is most likely because new treatment research and practice-based treatment developments and uses emerge every day, yet FDA approval protocols usually take years to go through. New treatment protocols for botulinum toxin use are being constantly, successfully developed.
Migraines
The treatment of migraine headaches, caused by aberrant neuro-muscular forces falls in the off-label use category, as do all other uses (other than those listed above) that you might be familiar with (i.e., crows feet and forehead wrinkles reduction).
Botulinum toxin A in Dentistry -
what is the connection?
The protocols for the treatment of bruxism – jaw clenching, teeth grinding and TMD dysfunction (Temporomandibular joint dysfunction) – were developed by a dentist, Dr. Howard Katz, and continuously improved upon for the last 10 years.
Scientific journals have now accepted the treatment with botulinum toxin A of habit-produced, pain caused by aberrant neuro-muscular forces in the masticatory system. Botox® or DysportTM injections for myofacial dysfunction (always showcasing a dentist delivering this treatment) have been the subject of numerous scientific papers.
Dentists as botulinum toxin A injectors?
Dentistry and its related specialties have made exponential increases in the functional and cosmetic treatment of the maxillo-facial region. Dentists historically have been involved in functional and cosmetic rejuvenation of the mouth and face, and newer technologies have enhanced the ability to make patients look and feel better. Cosmetic oral and maxillo-facial surgery is being taught in residency programs, is included in board examinations and represents a part of contemporary dentistry.
Dentists are the best suited and trained professionals to recognize and treat muscle disorders stemming from biting, jaw clenching and teeth grinding issues.
They have extensive head and neck anatomy training and are used to treating TMD dysfunctions. Dentists are highly trained in recognizing treating disease of the masticatory system. Additionally, a global diagnosis and treatment plan to include facial esthetics can enhance cosmetic dentistry and serve to frame the work of the restorative dentist.
How does it work?
Migraines are severe, continuous headaches that last for hours, days or weeks at a time. Myogenic TMD dysfunction is considered to be a transient (not constant) condition which (until this new botulinum toxin A treatment development) was treated by neurologists and dentists alike with systemic migraine medications and intra-oral devices (i.e. night splints/guards).
In their daily practice, dentists are confronted with patients who do not respond to conventional masticatory neuro-muscular treatment either because these treatments are ineffective or their compliance with dental orthotics is poor or both. Dentists are the most highly trained injectors in the oro-facial region.
Where are patients injected?
The injection sites are similar to those for cosmetic wrinkle reduction areas. Additionally, patients are being injected in the hair-line above the temples and in the back of the head.
Does it hurt?
No. Patients often claim to not even feel it.
How much does it cost, and how long does it last?
Depending on the amount of Botox® or DysportTM used, the cost starts at approximately $250 per area, approximately $1,650 if all areas need to be injected.
The therapeutic botulinum toxin A treatment lasts approximately three to six months, yet some of the patients treated did not need to have the treatment repeated because the aberrant teeth grinding/jaw clenching forces were stopped, the habit broken and their migraine headaches did not return. The evaluation needs to be made on a case by case basis though.
Other dental botulinum toxin A treatments available
Besides the above-mentioned migraine headache treatment, the other use for botulinum toxin A in Dentistry is for lowering of the upper lip on patients who suffer from excessive gum display when smiling (gummy smile). Properly placed botulinum toxin A will lower the lip to its ideal position. The result is a showcased smile without the distracting pink gum showing.
This procedure is inexpensive (approximately $250) and can be regarded as the most painless, temporary alternative to cosmetic lip surgery which is a permanent fix for the same problem performed by dentists.
Conclusion
As we all have seen in magazines, on TV and even with our own friends and family members, Botox® or DysportTM can bring therapeutic and cosmetic benefits to those who use it, but when inadequate treatment planning strategies and injection are implemented and performed, patients can be left looking fake and out of proportion. When choosing the option for botulinum toxin A injections for cosmetic or therapeutic reasons, please make sure that the person administering the treatment is fully trained and certified in the art and science of botulinum toxin A injections, and also has a comprehensive understanding of the relevant head and neck anatomy.
