Botox for Migraines?

Headache pain is one of the most common presenting complaints that we encounter as chiropractors. Headache pain, to include migraines, are among the disorders that evade traditional diagnostics. This means that the tests that are available to doctors like imaging and blood work and the like do not clearly point to the existence of a headache or migraine. The importance of this cannot be overstated. We were taught in school that our responsibility is to diagnose-to-tissue. Although time hasn’t changed this, the reality is that many disorders resist straightforward diagnosis and require us to think inductively and inferentially.

Botox Enters the Chat

Botulinum toxin, or Botox, has been approved by the FDA for the management of migraines since 2010. It enjoys some track record of success in the management of migraines. Is there something we can learn from this? Why would Botox help with a migraine? If there are any clues here it would seem to begin with the fact that Botox as a migraine intervention is injected into the muscles of the shoulders, neck and head. This is according to standard published protocols. [1]

How does this Help Migraines?

So, a treatment that affects muscles helps migraines? That is not at all a surprise to the chiropractor. The chiropractic adjustment has developed a reputation for being an intervention of the bones and joints. But the chiropractic adjustment is much more. Not only does the chiropractic adjustment address bones and joints but it directly affects muscles and nerves. Chiropractors have been helping people with headaches and migraine pain for a very long time. It should be understood that no chiropractor prescribes or un-prescribes any medication like a Botox injection.

But I think a very important point is missed if we overlook the significance of how a treatment like a Botox injection, which seems to be a direct muscle/nerve intervention, can have a predictably positive impact on something as difficult to treat as headache and migraine pain and not make the deductive leap that headache and migraine pain is very likely directly connected to the condition of our muscles.

Muscles/Tendons/Fascia

The muscles have long been the redheaded stepchildren of Western healthcare management. “It’s only soft tissue”-until it’s your soft-tissue. Western medicine has become inextricably bound to a care model that demands evidence-based medicine and reproducible findings, which has been wonderful for maintaining the standards of healthcare. Until you have a problem for which there is no reproducible evidence. Myofascial lesions such as trigger points defy traditional diagnostics. That means that there is no traditional test that finds a disorder like a trigger point.

Providers that treat myofascial disorders rely very heavily on tactile findings. Palpation. Unfortunately, tactile findings suffer from very poor inter-examiner reliability. [2] Simply put, if you brought five providers into the room one after the other and asked each of them to identify the muscular disorder of the patient it’s very unlikely that each would find the same thing or that they would use the same terminology to describe it.

While this may seem academic or even boring, it leads us to an important point: patients with pain disorders like headaches and migraines (along with many other pain conditions) need to be open to thinking outside the box—beyond the limits of traditional Western medicine—to find answers on their health journey. After many years I have come to realize that the care of the complex presentation will only be guided so far by traditional testing. Some of the most valuable empirical diagnostic information we get in the care of a patient is to carefully proceed with care and then watch for the patient’s response to the care effort. We are guided by successes. Patients that have success with the chiropractic care process have certain characteristics. Chief among these is that they’re willing to try and they are willing to participate. I can’t sit across the table from you and write a prescription for five adjustments. My patient has to understand the dynamic and interactive nature of the treatment process and some of the essential elements of lasting success. Getting adjusted has to become staying adjusted.

We hope this has been of some help and if you think you or someone you know might be helped further by our approach please feel free to reach out.

[1] Ray, J. C., Hutton, E. J., & Matharu, M. (2021, June 29). Onabotulinumtoxina in Migraine: A review of the literature and factors associated with efficacy. Journal of clinical medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC8269087/#sec2-jcm-10-02898

[2] MaherC, SimmondsMJ, Baderwitz-DoddLH, BinkleyJ, BurtonAK, FleissJL, & GrieveGP. (2005, October 19). Can physiotherapists locate lumbar spinal levels by palpation?. Physiotherapy. https://www.sciencedirect.com/science/article/abs/pii/S003194060566213X

Written by: Donaid Seals D.C

Dr. Seals is a practicing Doctor of Chiropractic with over 25 years of experience caring for people across three states. His thinking is the product of his education, practice experience and many years in the natural foods and fitness industry. He has become living proof that old muscleheads don’t die-or fade away; sometimes they grow up to bring real-world expertise to the clinical picture. Traditional background information is available here.