I have been approved for a year of Botox treatments for my migraines. They are only 1 of 6 pain issues with TN and I am not that enthusiastic to 31 shots of Botox. However, my doctor says he has been having success with injecting Botox in the mouth, close to the Trigeminal Nerve to block pain. He does it through the mouth as the same location on the face would cause drooping. Has any had Botox injected into your mouth and was it successful? Thank you.
I've heard of patients getting short-term relief from external Botox injections near the ganglion where the trigeminal nerve splits into its three branches. But I've never heard of one who received such injections directly into the mouth.
Richard, here's an interesting recent abstract from Pub Med. It may be worth your while to print this out and take it to a local University library for a school that has a Med School, to obtain the full text of the article. I can also track down the authors and ask for a copy, if you would like...
JRSM Short Rep. 2013 Feb;4(2):10. doi: 10.1177/2042533312472115. Epub 2013 Feb 12.
An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions.
Abstract
Botulinum toxin (Botox) is an exotoxin produced from Clostridium botulinum. It works by blocking the release of acetylcholine from the cholinergic nerve end plates leading to inactivity of the muscles or glands innervated. Botox is best known for its beneficial role in facial aesthetics but recent literature has highlighted its usage in multiple non-cosmetic medical and surgical conditions. This article reviews the current evidence pertaining to Botox use in the head and neck. A literature review was conducted using The Cochrane Controlled Trials Register, Medline and EMBASE databases limited to English Language articles published from 1980 to 2012. The findings suggest that there is level 1 evidence supporting the efficacy of Botox in the treatment of spasmodic dysphonia, essential voice tremor, headache, cervical dystonia, masticatory myalgia, sialorrhoea, temporomandibular joint disorders, bruxism, blepharospasm, hemifacial spasm and rhinitis. For chronic neck pain there is level 1 evidence to show that Botox is ineffective. Level 2 evidence exists for vocal tics, trigeminal neuralgia, dysphagia and post-laryngectomy oesophageal speech. For stuttering, 'first bite syndrome', facial nerve paresis, Frey's syndrome, oromandibular dystonia and palatal/stapedial myoclonus the evidence is level 4. Thus, the literature highlights a therapeutic role for Botox in a wide range of non-cosmetic conditions pertaining to the head and neck (mainly level 1 evidence). With ongoing research, the spectrum of clinical applications and number of people receiving Botox will no doubt increase. Botox appears to justify its title as 'the poison that heals'.
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The following articles discuss levels of evidence in evidence-based medicine.
http://en.wikipedia.org/wiki/Evidence-based_medicine
http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford
In general, Level 2 evidence is not considered as conclusive or strong as Level 1.
I am getting the 31 injections for my post MVD headaches. I have had a series of 3 so far. The first series took 7 weeks to work and I woke up without a headache and had to pinch myself to make sure I was still alive. The headaches stayed pretty much at bay -- then because of a change in insurance and a huge mess up on the insurance company's part, I did not get the injections until 120 days. Needless to say, it took forever again at which point my neurologist was not sure the Botox was the answer. He changed my meds and the pain was so severe that he went back to the Botox as well as a change in my meds. The cumulative effect of the Botox is suppose to be a miracle for the headaches. I will know when I can get them 90 days apart this time.
Long story short -- the injections are along the forehead, in the skull, neck shoulders and I get one in each jaw. The MVD pretty much made the TN pain go away however the headaches and the "mystery pain" behind my ear can be earth shattering. The surgeon that did the MVD insists that he has "never had this happen to a patient before". We did another MRI 18 months after the MVD and all he could say to me is nothing is wrong and good luck.
Now I have to wait for the 2 year anniversary of the MVD before another neurosurgeon will even schedule me for a second set of eyes. So, my neurologist and I just keep trying everything he can think of.
Wishing you the best of luck with your injections.......and please take someone with you to hold your hand. I for one cannot believe that people do it for cosmetic reasons.
I have had two Botox treatments and am schedule for number three in August. So far, the jury is still out on whether or not this treatment is successful. My doctor said that sometimes it takes up to three times to find some consistent relief. I seem to be seeing small decrease in pain post-Botox, but it is not substantial enough or consistent enough to make the call.
If you are concerned about the pain caused by the 31 shots, don't be. Literally the injection pain is almost non-existent. I know that I have a high pain threshold due to my ATN, but the shots literally don't hurt.
Good luck to you!