Migraine and Botulinum Toxin

Migraine and Its Modern Treatment

What is migraine headache?

Our senses send various impulses to the brain. These impulses turn into electrical currents in our nerves and reach the brain by passing through various nerve connections. Receiving these signals, the brain sends signals in response to the necessary targets. If there is a disorder in this system for various reasons, the pain system in the head-neck region (trigeminocervical) is stimulated inappropriately at certain intervals and the disease called migraine headache occurs. In other words, migraine is a disease that manifests itself with headaches that occur at certain intervals, end after a period of time, and sometimes reach unbearable severity.

Warnings and conditions that trigger migraine

  • Stress
  • Excessive noise
  • Strong odors
  • Hormonal changes in women
  • Sleeping too much or too little
  • Sudden changes in weather conditions
  • Strong or flashing (flickering) light

Some foods have also been observed to trigger migraines.

  • Alcohol
  • Pickle
  • Fermented foods
  • Some fruits and berries
  • Chocolate
  • Processed meat
  • Ripened cheeses

People at high risk of migraine

  • Women
  • People with a family history of migraine
  • People with various diseases: Depression, epilepsy, bipolar disorder, sleep disorder.

Findings (Symptoms)

Migraine has four stages:

  1. Preparation (prodrome)
  2. Initial symptoms (aura)
  3. Full onset of symptoms (symptomatic period)
  4. After pain (postdrome)

Preparation (prodrome) period: It starts about 24 hours before the pain. Conditions such as excessive yawning, unexplained changes in mood, cravings, and excessive urination may occur.

Initial symptoms (aura) period: It may begin just before or with the pain and continue throughout the pain. Weakness in the muscles, feeling that someone is touching or squeezing, visual disturbances (zigzag lines, flashes of light) may occur.

Symptomatic period: Pain that starts mildly and gradually gets worse is seen. It usually occurs on one side of the head and neck region. The pain is in the form of pulses that come and go. It is accompanied by nausea and vomiting, hypersensitivity to light, smell and sound. The pain is exacerbated by coughing, sneezing and moving.

Postdrome period: The patient feels weak, exhausted and confused. This may take up to a day.


The patient’s complaints are very important in the diagnosis. There is no method to make a definitive diagnosis. However, various tests including neurological examination, MRI (magnetic resonance) or CT (computed tomography) should be performed to rule out other diseases with similar symptoms. It is useful to remind the following again: There is no specific laboratory or imaging test to diagnose migraine.


There is no definitive treatment for migraine. The following can be done:

  • Medications: A wide variety of medications may be partially beneficial. However, their effects decrease when used for a long time.
  • Relaxing procedures: Resting in a quiet and dark room with your eyes closed, drinking plenty of fluids, and applying cold to the aching areas
  • Surgical treatment
  • Botulinum toxin treatment

Migraine Treatment in Plastic Surgery

Surgical treatment: In recent years, it has been observed that the pain in the head and neck region is relieved by relaxing the nerves of the area where the pain is seen, and the pain decreases or disappears.

Botulinum toxin treatment: It has been used for about 20 years. Its emergence has been with the observations of the patients. Migraine patients, like everyone else, have botulinum toxin applied to areas such as the face, neck and scalp for various purposes. Some migraine patients realized that they did not have a new attack for a long time after botulinum treatment. They even observed that the pain that occurred in mild degrees went away. These findings suggested that inactivating the nerve endings that cause pain with botulinum toxin is good for pain. Today, this treatment is widely used. Usually there is a muscle in the area where the pain is. Paralyzing these muscles or nerves with botulinum toxin provides significant benefits in some patients. However, since the effect of botulinum toxin is temporary, the treatment should be repeated at certain intervals.

Prof. Dr. Ege Özgentaş uses botulinum toxin in appropriate patients for migraine headaches and pain in regions such as neck and back. The muscles or nerves in the area of ​​pain are paralyzed with botulinum injections. However, for this, it is necessary to know the anatomy of the pain areas well and to make the injections to the right areas.

Ege Ozgentas M.D. Professor of Plastic Surgery