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Intradermal Botox for Migraine, Headache, Pain Disorders

by Teri Robert, Lead Expert

We've all heard a lot about Botox, botulinum toxin type A (BoNTA). It seems as if it's being used for something different every day. There are both cosmetic and medical applications for it. In the right hands, Botox is very helpful; in the wrong hands, it can be disastrous. If you're considering Botox treatments, don't hesitate to ask how much experience your doctor has with Botox administration.

Research into the most effective ways to use Botox for headache and Migraine treatment continues and is promising. Here, we'll take a look at research performed by John Claude Krusz, Ph.D., M.D., and William R. Knoderer, D.D.S., M.D., in Dallas. Please note that this research is based on intradermal (into the skin) administration of Botox. What you're probably used to reading and hearing about is intramuscular (into the muscle) administration of Botox.

Introduction:
It is known that botulinum toxin, type A, (BoNTA) often has marked effects on head pain and other pain. These can outlast effects on motor nerve fibers, and the mechanism may be an effect on nociceptive (caused by or responding to painful stimulus) sensory afferent (Transporting toward a center, When speaking of nerves, a sensory nerve that carries impulses toward the central nervous system) or non-cholinergic fibers. Intradermal administration was chosen to test this hypothesis for multiple types of painful conditions on the basis that nociceptive fibers are most numerous in the skin and that cutaneous (pertaining to the skin) sensory input contribute to these common painful conditions.

Rationale:
A growing body of preliminary data suggests that Botox (BoNTA) may have more widespread effects that pharmacologically go beyond its effects on cholinergic (Releasing or activated by acetylcholine or a related compound) motor nerve fibers. Recent studies have shown that Botox may block or inhibit release of glutamate (salt of glutamic acid that functions as the brain's main excitatory neurotransmitter) CGRP or Substance P from nociceptive neurons1-3. These data may explain, in part, the well-known effect of Botox to reduce pain longer than its ability to reduce muscular problems/deformities.

Krusz and Knoderer previously reported initial success in treating headaches of cervical (related to the neck) origin with both Botox and BoNTB4-6. The study referred to in this article extends their initial findings with additional data utilizing intradermal Botox in other painful states. The index case was a patient with CPRS, type 1 (reflex sympathetic dystrophy, aka complex regional pain syndrome), in whom relief of burning pain, swelling and painful radiating symptoms became dramatically better with intradermal Botox.

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