My last post introduced the concept of Botox use in the dental office. I have spent the better part of this year studying the theory and history of Botox as it relates to TMD and symptoms associated with TMD. For patients who have tried all other modes of therapy without pain relief, this is an exciting treatment with virtually no side effects or recovery. The clinical effects of Botox on TMD/clenching/tension headaches include a decrease in pain, decrease in sensitivity, decrease in the intensity and duration of headaches/clenching as well a decrease in the number of episodes experienced. Classic migraines involve pain, nausea, and visual changes. Patients who suffer true migraines may not benefit from Botox injections. However, if your migraine headaches are caused by or exacerbated by TMJ disorders you will very likely experience improvement in symptoms. In other words, if tension-type headaches are present simultaneously with myofascial pain it is very well within our purview as dentists to provide treatment and we can do so quite successfully. Note – true migraines must be diagnosed by an MD. As I’ve mentioned in my previous blog, Botox is not the first line of treatment. If you’re interested in Botox for TMD be sure that you’ve investigated all other modes of treatment. What makes Botox different from all other treatments? Botox is nonsystemic so you can avoid unwanted side effects such as GI upset, fatigue, confusion, depression, liver toxicity and other effects commonly attributed to systemic medications. Botox is also considered a focal therapy and as such, it is administered directly into the desired site of action. Major injection sites include the frontal, temporal, masseteric, occipital and suboccipital muscles. For chronic migraines, the typical protocol is 31 small injections throughout these sites and anywhere from 155-195 units of Botox. My final blog will outline contraindications to Botox therapy as well as pre and post Botox instructions.