By Dr. Joel Gould An Unexpected End to Aches and · PDF file instant smile makeovers. Dr....
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F rom the most glamorous stars in Hollywood whoneed to stay beautiful for the camera, like Oscar-winning actress Nicole Kidman and pop starMadonna, to average Americans who simply want to improve their appearances, Botox has en-
joyed a wide embrace by the many medical practitioners who routinely use it on their patients with great success. Since its FDA approval and introduction to the public over a quarter-century ago, Botox has enabled millions of pa- tients around the globe to reduce or eliminate both facial muscle conditions and cosmetic skin issues alike. Over 6 million Botox procedures are performed annually, making it the most common cosmetic operation today, keeping skin tight and smiles bright.
In recent years, Botox has been approved by the FDA to specifically help alleviate the pain of those who experience persistent and severe migraine headaches and muscle ten- sion around the face, neck and head. This includes the tem- poromandibular joint, also called TMJ, which when overstimulated by stress, clenching and grinding, can also contribute to severe pain and tension headaches. The re- sultant pain is called Myofascial Pain Dysfunction Syn- drome, or MFPD, also commonly referred to as TMJ. For some patients, Botox use has dramatically changed their
lives, enabling them to resume dynamic activity, as well as the many other common experiences that most of us enjoy in good health.
But how does Botox work in these areas of the head and face? While medical leaders and researchers previously be- lieved that severe headaches were driven by spasmodic blood vessels, many now understand that the high tension and repeated spasms of several flat muscle groups are re- sponsible for migraines and TMJ. Botox causes partial muscle paralysis when injected locally to such tissues. It does this by dulling nerve endings that ordinarily trigger spasmodic muscle activity and it helps to interrupt recur- rent pain cycles in patients.
Migraine headaches are those that occur to patients over half of the number of days in any given month. In addition to the severe pain in their head and face, sufferers often ex- perience sustained feelings of nausea, as well as extreme sensitivities to light and sounds. There are a few different varieties of migraine headaches and, as such, some patients respond much better than others to Botox. Patients with migraines who feel that their face or head is being “squeezed” respond favorably to Botox, as well as those who experience facial muscle spasms or tension headaches. However, those with headaches between their eyes in the
By Dr. Joel Gould
your look ● the smile dr
While most people equate Botox with a wrinkle-free face, the popular treatment has been helpful in eliminating severe headaches
An Unexpected End to Aches and Pains
“orbit” area, those with headaches on the top of their head, on their cheeks or behind the ears have very little success with Botox.
A key area of the face that is amenable to Botox use is the upper mandible, where TMJ often occurs. As one of the most common orofacial pain sources for women and men, TMJ affects nearly a third of the population for those in their adult years. The causes of TMJ vary, though medical authorities believe it begins with indirect trauma or other psychological stressors. However, many patients have de- veloped muscle or tendon disorders, which in combination with stressors, cause the symptoms of TMJ. Pain and ten- derness where the upper jaw meets the temporal bone structure are often the first signs of TMJ, followed by lim- ited use of or locking of the jaw, as well as repeated popping sounds that coincide with mandibular action during eating. The location of TMJ is crucial for its contribution to relat- ed migraines, myofascial pain and tooth pain. There, a col- lection of tendons, dense facial muscles and large nerve pathways intersect and extend outward. Often in TMJ, re- peated subconscious clenching of the jaw or teeth, called bruxism, contributes to the problem.
Luckily, bruxism, migraines and TMJ have been greatly reduced by Botox use amongst patients. Doctors, dentists, fa- cial plastic surgeons and trained medical personnel often ad- minister Botox to their patients in several short sessions over time. Botox is injected with a small syringe in one of about four typical locations on the face or head. These include the temple region, the forehead, the inner orbital area near the eye or the upper region of the patient’s neck. Depending on the acuity of the medical condition, anywhere from 4-10 in- jections of 2-5 units are administered to each area.
In many cases, patients are injected symmetrically, even if one side is the pain site, so that it does not switch to the opposing side of the face or head. Patients often improve greatly over the next few weeks or months. Botox is largely injected to the patient sites every three or so months to re- duce the muscle tension that initiated their migraine and TMJ issues. It is an important goal to reduce the stressors that cause clenching and tension headaches; however, Botox allows the body to rest and repair, as well as not re- spond incessantly, which causes severe symptoms. This, in turn, enables patients to eventually reduce medication use and adjust behavior or destructive responses to stressors.
Despite FDA approval of Botox specifically for migraine headaches and other related maladies, many medical insur- ance companies do not cover the use of the medication. Often, a medical insurance company will require a patient to prove that his migraine has occurred over half of a year, for a majority of days in the month and for several hours every day. That same patient must have tried several other known prescription treatments for his condition. At that point, the neurologist must make a strong recommendation for the use of Botox in the patient’s treatment. Only then can a patient qualify for insurance coverage of Botox use for migraines.
As Botox is derived from the neurotoxin and bacteria
known as botulism, it can cause some uncommon side ef- fects. These include muscle paralysis and allergies. Some have encountered breathing issues, speech disorders, bruis- ing, dry mouth, difficulty swallowing and others. A few deaths have been directly linked to Botox use, but none from cosmetic or migraine headache patients.
Many celebrities have, of course, used Botox for cosmet- ic purposes over the years with great effect. A few on the list of those who are open about their Botox use include tel- evision star Courteney Cox, Academy Award winner Gwyneth Paltrow, comedienne Jenny McCarthy, morning talk show host Kelly Ripa and supermodel Cindy Craw- ford, among others. Virginia Madsen, co-star of the award- winning feature motion picture Sideways, specifically used Botox to alleviate or reduce her recurrent migraine symp- toms and stay beautiful, too.
Today, Botox has helped to reduce and prevent migraine headaches, facial pain and TMJ in millions of patients everywhere. The good news is that in the process, it also helps make facial wrinkles diminish and disappear, too. It’s important to learn more about the dynamic benefits that Botox offers through qualified doctors or medical person- nel who understand the practical applications of the med- ication and who use it regularly. With their help, migraine sufferers have been able to see the light at the end of the tunnel—and add a big helping of beauty in their lives. �
Dr. Joel Gould has been practicing in Manhattan Beach since 2001. His general and cosmetic dental office treats patients of all ages and offers a broad range of treatments. Dr. Gould owned several practices in Vancouver, Canada for 10 years before moving to the Los Angeles area, and he has trained with several Beverly Hills plastic surgeons in the art and science of Botox and Juvederm. He collaborated with Dimitri’s dental studios to create the “supermodel veneer” which he uses in his instant smile makeovers. Dr. Gould recently launched his new concept called “Modern American Dentistry,” a no-nonsense approach to mod- ern dental practice. With three locations, and five dentists, he has creat- ed a dental experience that is consistently comfortable.
GROWING PAINS: Kristin Chenoweth is a musician and actress who began suffering from migraine attacks at least once a week. This prompted her to talk to her doctor about finding a suitable treatment. Since then, she has been receiving BOTOX® injec- tions, which have been approved for fighting mild migraine symptoms.
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