Can Botox for migraines cause pain deep inside of the ear and jaw pain? (Photo)

injection of Botox for migraine should not cause any pain; however, it sounds like a vessel was inadvertently hit and formed a small hematoma that impinged on some nerves and that was the cause of the pain which should go away completely and does not mean anything

You never mentioned in your question where the botox was exactly injected and what was the condition that was being treated. Good luck from New York City

Thank you for your question. You’re asking if Botox® for migraines can cause pain inside the ear. You describe after about an hour and half after you got some Botox® for migraines, as pointed out in the diagram, you developed an area of swelling. Although your neurologist was away, your general practitioner noted there might be a possibility of a lymph node, and the pain in the ear got worse with chewing.
I can share with you my thoughts on what I think the ideology of your pain after this injection. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I have been treating patients with Botox® since 1993. In fact, oculoplastic surgeons and neurologists have been the first doctors to use Botox® for neurologic issues such as facial spasms. Migraine treatment evolved out of the treatment of facial muscles, where patients who have migraines noted that they appeared to get better when they had Botox® for facial muscles.
There is most likely an explanation for your situation. The muscle where Botox® was injected was the temporalis muscle. This muscle is important in terms of helping you with the migraines, but is also a muscle used for chewing. It seems likely, based on your history, that when the injection was placed, a vessel could have been traumatized that led to bleeding within the muscle, or hematoma, and that’s where swelling likely originated, especially with that timeframe. It’s not the Botox® itself, but rather the trauma of the placement of the needle. This muscle area is fairly vascular, so it’s not surprising. It could have been a small vessel feeding the muscle, so it’s not necessarily a major vessel.
That said, as that hematoma clears, there’s going to be some pressure on nerves that also happen to provide sensory and innervation in the ear. The fact it’s aggravated by chewing further verifies this idea. Most likely, as this hematoma clears and as the inflammation this area clears, the pain should get better. Again, it’s not likely the Botox® itself but rather the swelling responsible for this pain perception.
I think once you’re able to discuss this with your neurologist, you can probably clinically see improvement in the course of a few days as this resolves. Talk to your neurologist about this. From my own practice, a lot of patients do have Botox® for migraines or actually come to me because they get Botox® for cosmetic reasons, and helps them for migraines. People with more extensive migraines or frequent migraines typically go to neurologists who have more expertise and experience with Botox® for migraines, at least in comparison to an aesthetic specialist like myself.
Review this with your neurologist. If there isn’t resolution, you might consider some imaging studies, but chances are it’s going to get better without any intervention or further investigation. I hope that was helpful, I wish you the best of luck, and thank you for your question.