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 simplywant to improve their appearances, Botox has en-

joyed a wide embrace by the many medical practitionerswho routinely use it on their patients with great success.Since its FDA approval and introduction to the public overa quarter-century ago, Botox has enabled millions of pa-tients around the globe to reduce or eliminate both facialmuscle conditions and cosmetic skin issues alike. Over 6million Botox procedures are performed annually, making itthe most common cosmetic operation today, keeping skintight and smiles bright.

In recent years, Botox has been approved by the FDA tospecifically help alleviate the pain of those who experiencepersistent and severe migraine headaches and muscle ten-sion around the face, neck and head. This includes the tem-poromandibular joint, also called TMJ, which whenoverstimulated by stress, clenching and grinding, can alsocontribute 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. Forsome patients, Botox use has dramatically changed their

lives, enabling them to resume dynamic activity, as well asthe many other common experiences that most of us enjoyin good health.

But how does Botox work in these areas of the head andface? While medical leaders and researchers previously be-lieved that severe headaches were driven by spasmodicblood vessels, many now understand that the high tensionand repeated spasms of several flat muscle groups are re-sponsible for migraines and TMJ. Botox causes partialmuscle paralysis when injected locally to such tissues. Itdoes this by dulling nerve endings that ordinarily triggerspasmodic muscle activity and it helps to interrupt recur-rent pain cycles in patients.

Migraine headaches are those that occur to patients overhalf of the number of days in any given month. In additionto the severe pain in their head and face, sufferers often ex-perience sustained feelings of nausea, as well as extremesensitivities to light and sounds. There are a few differentvarieties of migraine headaches and, as such, some patientsrespond much better than others to Botox. Patients withmigraines who feel that their face or head is being“squeezed” respond favorably to Botox, as well as those whoexperience 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 equateBotox with a wrinkle-free face,the popular treatment hasbeen helpful in eliminatingsevere headaches

An UnexpectedEnd toAchesand Pains

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“orbit” area, those with headaches on the top of their head,on their cheeks or behind the ears have very little successwith Botox.

A key area of the face that is amenable to Botox use isthe upper mandible, where TMJ often occurs. As one of themost common orofacial pain sources for women and men,TMJ affects nearly a third of the population for those intheir adult years. The causes of TMJ vary, though medicalauthorities believe it begins with indirect trauma or otherpsychological stressors. However, many patients have de-veloped muscle or tendon disorders, which in combinationwith stressors, cause the symptoms of TMJ. Pain and ten-derness where the upper jaw meets the temporal bonestructure are often the first signs of TMJ, followed by lim-ited use of or locking of the jaw, as well as repeated poppingsounds 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 nervepathways intersect and extend outward. Often in TMJ, re-peated subconscious clenching of the jaw or teeth, calledbruxism, contributes to the problem.

Luckily, bruxism, migraines and TMJ have been greatlyreduced 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 overtime. Botox is injected with a small syringe in one of aboutfour typical locations on the face or head. These include thetemple region, the forehead, the inner orbital area near theeye or the upper region of the patient’s neck. Depending onthe 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, evenif one side is the pain site, so that it does not switch to theopposing side of the face or head. Patients often improvegreatly over the next few weeks or months. Botox is largelyinjected to the patient sites every three or so months to re-duce the muscle tension that initiated their migraine andTMJ issues. It is an important goal to reduce the stressorsthat 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, inturn, enables patients to eventually reduce medication useand adjust behavior or destructive responses to stressors.

Despite FDA approval of Botox specifically for migraineheadaches 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 patientto prove that his migraine has occurred over half of a year,for a majority of days in the month and for several hoursevery day. That same patient must have tried several otherknown prescription treatments for his condition. At thatpoint, the neurologist must make a strong recommendationfor the use of Botox in the patient’s treatment. Only thencan a patient qualify for insurance coverage of Botox use formigraines.

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. Somehave encountered breathing issues, speech disorders, bruis-ing, dry mouth, difficulty swallowing and others. A fewdeaths have been directly linked to Botox use, but nonefrom 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 thelist of those who are open about their Botox use include tel-evision star Courteney Cox, Academy Award winnerGwyneth Paltrow, comedienne Jenny McCarthy, morningtalk show host Kelly Ripa and supermodel Cindy Craw-ford, among others. Virginia Madsen, co-star of the award-winning feature motion picture Sideways, specifically usedBotox to alleviate or reduce her recurrent migraine symp-toms and stay beautiful, too.

Today, Botox has helped to reduce and prevent migraineheadaches, facial pain and TMJ in millions of patientseverywhere. The good news is that in the process, it alsohelps make facial wrinkles diminish and disappear, too. It’simportant to learn more about the dynamic benefits thatBotox 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, migrainesufferers have been able to see the light at the end of thetunnel—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 andoffers a broad range of treatments. Dr. Gould owned several practices inVancouver, Canada for 10 years before moving to the Los Angeles area,and he has trained with several Beverly Hills plastic surgeons in the artand science of Botox and Juvederm. He collaborated with Dimitri’sdental studios to create the “supermodel veneer” which he uses in hisinstant smile makeovers. Dr. Gould recently launched his new conceptcalled “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.

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GROWING PAINS: Kristin Chenoweth is a musician and actress who began sufferingfrom migraine attacks at least once a week. This prompted her to talk to her doctorabout finding a suitable treatment. Since then, she has been receiving BOTOX® injec-tions, which have been approved for fighting mild migraine symptoms.