What is Botulinum Toxin (Botox)?

Botulinum toxin is obtained from a bacterium called “Clostridium botulinum”. In other words, it is not snake venom as it is mentioned among the people. This substance partially blocks the nerve impulses to the target organ and creates a temporary and reversible paralysis in the target area.

For what purposes is Botox used?

It’s used cosmetically in the treatment of superficial / medium and deep wrinkles, for eyebrow lifting, in cases where there is excessive sweating in areas such as armpits / hands / feet (hyperhidrosis), excessive teeth clenching and masseter hypertrophy, in cases where the gums appear more than normal when talking or laughing (gummy smile) and in the treatment of chronic migraine. In addition to these, it is also indicated in spasticity, cerebral palsy, spasmodic torticollis, blepharospasm, hemifacial spasm, cervical dystonia, and bladder spasm.


What is migraine and how is it treated?

Migraine is a type of headache that affects the daily life, social life, and quality of life of the patient. Many etiological and pathophysiological factors have been described for its cause. In its treatment, regulation of environmental factors, pharmacological drugs, botulinum toxin (Botox) injections and surgical interventions are used.


How does Botox application affect migraine?

Botulinum toxin (Botox) application was approved by the FDA in 2010 for the treatment of chronic migraine. Botulinum toxin inhibits the release of acetylcholine at the muscle-nerve junction.


Can every individual who thinks they have a migraine get a Botox injection?

Migraine is a complex condition explained by many different etiological and pathophysiological factors. Therefore, the individual should be evaluated in detail by a neurologist before Botox application in order to make the differential diagnosis, find the cause, evaluate the symptoms, understand the triggering factors and trigger points, make lifestyle changes and evaluate the treatment options.


For migraine which areas is it applied to?

The application areas differ from the areas used for wrinkles. After the evaluation, injections are made to the forehead, temple, nape, and neck region.


How is Botox applied?

There is no need for operating room conditions for this procedure. It is one of the applications that can be done easily in office conditions where sterility principles are taken into account. Injections are made to the target areas with the help of very small needles (32G, 33G). The process takes an average of 15 minutes. After the procedure, you can return to your daily life.


When does the effect start after Botox application for migraine treatment?

The effect of the application starts after 1 week. It is normal to see no effect until this time. The maximum effect is seen between 4-6 weeks.


How long does the effect of botulinum toxin Botox application for migraine treatment last, what are the factors affecting the permanence?

In the treatment of migraine, the effect of botulinum toxin lasts for an average of 6 months. The duration of botulinum toxin administration varies according to the pathophysiology of migraine and individual factors. Avoidance from triggering factors, lifestyle, age, smoking, nutrition and personal reasons are among the most important of these variable factors. There may be situations where the effect is not as long and effective as expected. In this case, the development of resistance is investigated, dose adjustments are made, or other subtypes of botulinum toxin can be applied. It should be noted that sensitivity and results may vary from person to person. If you have been treated with botulinum toxin too often before, or if the dose was too high, your body may start to produce certain substances called antibodies to the botulinum toxin, and these substances can reduce the effect of the newly injected botulinum toxin.


How often should Botox application be repeated?

It is thought that the duration of action is prolonged in repeated applications. The interval between two botulinum toxin treatments should not be shorter than 3 months.


What should be considered after Botox application?

In order to prevent the unwanted spread of botulinum toxin on the day of application, the application areas should not be massaged, you should not be lying face down or sideways, and the swelling should not be tried to be distributed. Activities such as hammam, sauna and heavy exercise are not recommended on the application day. You can take a shower (not too hot or cold!) or wash your face after the application. There is no restriction on the next day of the application, and it is possible to return to the daily routine, including make-up.


Is Botox application painful?

Since the injection needles used are quite small, the pain is minimal. Patients describe the situation with expressions such as “as much as a mosquito bite”. Local anesthetic injection is not recommended before the procedure, as it will affect the distribution of Botox. If necessary, superficial anesthesia can be provided with topical creams before the procedure. After the procedure, the pain in the injection sites will also pass in a very short time.


Will there be bruising after Botox application?

Rarely, small bruises may occur due to damage to the small vessels in the application area. This does not change the effect and result of botulinum toxin treatment. After the procedure, it is recommended to apply ice to the bruised area without massaging and pressing hard. If a bruise occurs, it will go away in 3-4 days, and the use of foundation during this time will mask the bruise.


What are the other problems encountered after Botox application?

As a result of Botox application for migraine treatment, there may be an increase in headache in the first days. This condition decreases in 3-4 days. Very rarely, an allergic reaction may develop after botulinum toxin injection. If you experience difficulty in breathing, swallowing or speaking or if you experience hives, swelling (including swelling of the face and throat), wheezing, fainting, and shortness of breath after the injection, contact your doctor or nearest healthcare facility immediately, as these are possible signs of a severe allergic reaction.


Who is Botox not applied to?

Botox injection is not applied in the presence of active infection in the area where the injections are planned, in neurological or neuromuscular diseases (Motor neuropathies, ALS, Myasthenia Gravis, Eaton-Lambert Syndrome…), in drug use such as aminoglycosides (gentamicin…) and curare-like non-depolarizing blockers, in case of lactose and albumin allergy, during pregnancy and breastfeeding. In addition, if it is thought that botulinum toxin (Botox) injection will not be beneficial in the evaluation made by the neurologist, the application is not done again.


Migraine is a complex disorder that affects social life immensely and is still being researched. Botulinum toxin (Botox) injections have been used in the treatment of migraine in recent years and very successful results have been reported in the studies. The application is quite simple and effective, but it is very important to get the opinion of a neurologist before the treatment of migraine. Medical aesthetic applications such as botulinum toxin application should be applied by doctors who have both theoretical and practical knowledge and experience in skin and subcutaneous anatomy, have a deep knowledge of the subject, can manage the complications and are experts in their field. Best regards.