Botox for Headache: Mechanism of Action??

In answer to questions of why Botox(botulinum toxin type A..there is now, in the US, another strain of type A, Dysport...)works, it probably is NOT by relaxing muscles, but rather:
Botox actually is an anti-inflammatory, decreasing, or antagonizing, the inflammatory(neuronal/brain) compound CGRP. CGRP, which several companies are focused on as far as new migraine meds, is crucial in "central sensitization', which perpetuates chronic headache. So, it may not matter that much where we give the Botox, as long as it is in the general area of pain..I have done Botox injections since 1998, almost 3,000 times, and I STILL am not sure the best places to give it; the usual is frontal and temporal, sometimes occipital as well...and we "chase the pain", giving it where the pain and tenderness(allodynia) are.
In general, with few exceptions, we do not use a drug(such as Botox) to determine a diagnosis; there are many examples of Imitrex(sumatriptan) working for headaches that were from a subdural bleed, or a brain tumor, or meningitis. If Botox works, it does not tell us the exact nature of the underlying headache. I do believe, and studies indicate, that Botox is effective in about 60% of patients, at least for 2 to 3 months.
Lawrence Robbins,M.D. http://www.headachedrugs.com

Dr. Robbins: one of my first-line-of-defense meds is indocin (both capsules and suppositories), which I understand is an anti-inflamimtory, too. I often get relief from it. I have had botox treatments in the past, and recall that once the treatment was quite successful, once it was not at all successful, and I don't recall what happened on the third trial but I suspect it wasn't successful because I stopped treatment.

Why would it only help once or twice but not all times? Is it the location of injection, is it dosage, is it how long I have been in that pain cycle, or is it completely random and still not understood?

I think the answer as to why Botox, or a preventive med, may sometimes work, and not others, is a mystery.....for many, the preventives wear out, even when they work for awhile....L.Robbins,M.D.

Dr Ordon said on his blog on 14/December/2009 on www.thedoctorstv.com: Botox for migraine: The reason for this is because Botox is used in muscles, not nerves.
While the truth is:
Botox blocks muscular nerve signals:
http://www.aad.org/public/publications/pamphlets/cosmetic_botulinum.html

(Botox injections work by weakening or paralyzing certain muscles or by blocking certain nerves):
http://www.nlm.nih.gov/medlineplus/botox.html
Now Dr Robbins says other thing: 1- (it probably is NOT by relaxing muscles, but rather): When you say PROBABLY= THIS MEAN YOU DONT KNOW.
2- (Botox actually is an anti-inflammatory, decreasing, or antagonizing, the inflammatory (neuronal/brain) compound CGRP. CGRP, which several companies are focused on as far as new migraine meds, is crucial in "central sensitization', which perpetuates chronic headache.): decreasing, or antagonizing= when you put OR that mean it's not fact.
Give me the link where you read that Botox is used as an anti- inflammatory drug.
I give you too many links that show you how really Botox works (paralyzed the neuronal signal to go to the muscles): see my response to Dr. ORDON.
If you see any anti-inflammatory effects from Botox injection you have to know that he work also on the muscles of the arteries walls so Botox don't allow to the arteries to do ACTIVE VASODILATATIONS which cause all kinds of vascular headaches. You can see the artery in time of migraine attack how it's too big than normal. This explain also the pulsate kind of migraine headaches, because with every blood flow through the vessels this make diameter of the vessels much bigger so more physical action on the sensitive nerves around the arteries walls. So the effects as anti-inflammatory from Botox come from this action, and it works as when you put an ice on the area.
3- (I have done Botox injections since 1998, almost 3,000 times, and I STILL am not sure the best places to give it;): Because you don't give your attentions to the arteries branches in the area, do it and you will see the difference.
When you know how to use good any treatment, then you will see the good results for all migraine patients.
BOTOX, works as works too many animals poisons: paralyzing.

All migraine important secrets were discovered by my work.
You can ask anything you wish about migraine.
Migraine headaches became a history for all my migraine patients.

We know...

I had the botox injections 2 times. Both times I couldn't move my head, somthing locked up in my neck! Didn't help the migraines either.

I'm going in for my botox injections again today. $515.00 out of my pocket in a few short minutes.

I'm really hoping this round works. I've had three (not consecutive) that have not worked, or only partially worked.

I bravely booked a vacation, using my positive thinking to will myself well for the vacation. Managed to find a hot vacation spot with an almost direct flight so only eight hours travel time if all goes as planned.

Today, my botox will be injected by the headache specialist rather then my neurologist who usually does it.

"Fingers crossed"

I NEED to get rid of these damn migraines!!!!!

Maybe your headache specialist will be better than my neuro. I sure do hope so!

I have been so bad for about 3 weeks now, could figure out why, I put 2 and 2 together, and it's the new anti-depressent they put me on to prevent migraines, it actually gave me terrible headaches everyday. I have exhausted all my migraine meds for the month in 3 weeks time! I am glad I at least figured it out.

I hope you have a good vacation!