Is it normal to have a headache 2 weeks straight after Botox on forehead only?

Question

I had my second round of botox 2 Fridays ago and had a tension headache since the headache wore in. I had 20 units.

Jason Emer, MD · Answer

While headaches may occur after Botox, they generally don't last weeks after treatment. If it persists, I recommend following up with your Doctor. Botox results resolve in 3-4 months. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  It is common for some patients to develop a headache after initial Botox injections but this may occur in the first 24 hours after treatment.  By two weeks your botox should have settled in, helping avoid headaches.  I would discuss your symptoms with your injector to make sure all is well.

Monika Soni, MD · Answer

Thank you for your question alvt88. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.

Michele S. Green, MD · Answer

A headache from Botox is possible but a persistent headache lasting two weeks from Botox would be highly unusual.  I would consult a neurologist to evaluate your headaches.  Please keep us posted.  Best, Dr. Green

Selena Lantry, MD · Answer

While patient’s sometimes may get a headache following a Botox injection, it is not normal that it would last two weeks.  For now, you can treat your headache with ibuprofen, Tylenol, or aspirin as well as with hot or cold compresses.  Next, I would recommend following up with your provider or doctor to discuss your persistent headache.

Paul Fondacaro, MD · Answer

Headaches may occur after administration of Botox in a small number of patients. When that happens I usually recommend extra strength Tylenol. However, if the headache persist i find that Alleve being an anti-inflammatory agent does the trick. A headache lasting more than two weeks is unusual and I would consult with your physician just to be on the safe side

Jean M. Casello, MD · Answer

Some patients have reported headaches after botox. Usually the headache will last 24-48 hours and responds well to tylenol and heat.  If you are still having a headache after 2 weeks I would suggest that you contact your provider and be evaluated.

Paul Blair, MD · Answer

Some people will have a headache after their initial Botox injection.   it's unusual for it to last two weeks, but possible.   Normally, subsequent injections of Botox , headaches are not a common complaint.  Please follow up with your injector.

Leonard Grossman, MD · Answer

Having a headache after the injection of Botox is not a very common condition but it does happen. On the other hand having a headache for 2 weeks after the treatment is even more uncommon. I would try applying warm compresses and take some anti-inflammatories and at the same time discuss this with the treating physician. Good luck from New York City.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question alvt88. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam where the entire medical history is reviewed. However, I hope the information provided here is useful.The pivotal studies used 20 units of Botox in the forehead area above the brows to address the horizontal lines seen when one raises the brows. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.The pivotal studies for the horizontal lines on the upper forehead were published many years after doctors had been using Botox. In these studies, 20 units of Botox were used to treat this area. However, in my experience I find that anywhere from 10 to 20 units works well in this area. For patients with narrow foreheads a lower dose may be used and those with a broad forehead generally require higher doses. I have also found that the full results in this area are seen by two weeks. Therefore, we have our patients return two weeks after their treatment to assess the results via photographs. At that point additional units may be used if further enhancement is desired.When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.Botox works to treat migraine headaches in the same way it works to treat wrinkles: by relaxing muscles. In the case of migraine headaches (and sometimes other headaches such as tension headaches) the muscles in the upper face and head contract. This puts pressure on the bones which can be very painful.  Botox will relax the muscles to relieve the pain. The areas treated with Botox for migraine headaches are those treated in the upper face. Sometimes additional muscles are also treated with Botox such as those in the temples and back of the head. The dose of Botox used is in the range of 60 to 70 units. Full results are seen in two weeks and after a Botox treatment. However, many patients feel improvement as early as the next day after a Botox treatment.  Botox treatment for migraines will significantly reduce the frequency of migraines and is a great alternative for those for whom oral medications are ineffective. Most people enjoy their results from a Botox treatment for three to four months. At that time a maintenance treatment is recommended.The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.
With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  Another side effect, which is uncommon, is headaches. This is possible for a few days after a treatment. For my patients I recommend over-the-counter Tylenol for pain relief. If I had a patient who had headaches for two weeks after a treatment I would recommend that she return to her provider for an evaluation and possibly visit her primary care provider or a neurologist for further evaluation.
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Is it normal to have a headache 2 weeks straight after Botox on forehead only?

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