Brow and eyelid heaviness a few weeks after Botox for migraines, is this normal?

Botox can be a great solution for chronic migraine sufferers.  However, because of the amount and placement of Botox normally used by Neurologists, it is commonly associated with brow heaviness or drooping in patients.  The placement of the injections tends to be not in the best location for cosmetic results.   Sometimes, additional injections into the frowning muscles may alleviate this.   It may be best to try a lower dose in the forehead next time and see if that is as effective for the migraines.

Heaviness should resolve in a few days, if heavy after a few weeks it likely will stay that way for a few months till fully worn off.  Best, Dr. Emer.

Thank you for your question.  Brow heaviness after Botox treatment can be either physical or subjective.  Sometimes the treatment was more than adequate and sagging of the brow can occur.  Other times, it is appropriate and the brow looks good but the patient has a sensation of heaviness.  In this instance one would infer that the sensation is due to not moving the brow and as such one would expect to get acclimated to it and not be an issue.  On the other hand, if the brow is sagging then the treatment may need to be adjusted. 

The development of brow and/or eyelid heaviness after Botox is dependent mainly on the placement of the injections but can also be influenced by the dose used.  Without knowing exactly where your injections were placed and the dose used to treat your migraines, it is difficult to answer your question.  It may be possible to adjust the placement of the injections and/or the dose used to prevent the brow and eyelid heaviness you are experiencing.  I would discuss this with the physician who treated you.  

Unfortunately, this is relatively common when Botox is being used to treat migraines. It happens for two reasons. Migraine treatments generally use a higher dose of Botox, and neurologists tend to focus more on the migraines themselves when they inject, and less on the aesthetic outcome. In my practice, I have many migraine sufferers who prefer the techniques that we use as an aesthetic practice to those used by their neurologists for this exact reason. However, neither approach is wrong, they are just different styles. If this does not bother you, and you are feeling relief from your migraines, then there is no need to do anything differently!

Botox can be a great treatment for migraines.  Unfortunately, brow heaviness is a potential side effect.  The risk for this side effect varies depending on the volume injected (ie, the number of units), the precise location of the injections, and the skill of the injector.  Fortunately, this effect will almost certainly be temporary.  You should find that the heaviness resolves with time.  

I agree with all the other doctors comments below. Very often physicians giving Botox for migraines are not aestheticly inclined usually neurologists. So they tend to give the Botox too low on the forehead, very often right above the eyebrows. This blocks the frontalis muscle which elevates our eyebrows, which is why your eyebrows are low or feeling "heavy". I have a  number of my cosmetic patients tell me their headaches are better after I give them Botox cosmetically. So to prevent the eyebrow droop and get good headache relief the physician should keep the forehead injections in the upper half of the forehead and the glabellar region(between brows) only. If they keep giving the injections low in the forehead the eyebrows will continue to droop or feel heavy afterwords.

It is very possible for Botox to actually make the eyelids droop, but many times the heaviness we feel is due to the fact that we can no longer lift the brows.  Some people who are heavy in the lids and brows to begin with use their foreheads a lot to raise the lids or as they focus on things.  With Botox in place in the forehead, those lifting muscles are paralyzed and you can no longer raise the forehead muscles, which leads to a feeling of heaviness.  Most people get used to that after awhile!However, definitely check with your injector to make sure you aren't getting too much; they could try reducing the dose to see if it helps, but at some point too low of a dose may not control your migraines.  Since Botox only lasts 3 months, you can adjust the dose next time and see what you think.  It may take a few treatments to get it just right!Good luck, and I'm glad your migraines are better!   

Thank you for your question.  Heaviness after Botox is typically due to dosage and location.  For migraines the on-label indicated dosing and treatment sites are slightly different than for cosmetic use.  For migraines the Botox is to be diluted to 5units/0.1mL vs cosmetic the indication is 4units/0.1mL.  Additionally for migraines, the  injection points for the frontalis muscle (forehead) is indicated as 20 units divided into 4 injection points or 5 units per injection as opposed to cosmetic Botox we are typically using 10 units or less in the frontalis in 1 unit injections.  The increase in dosage may be a cause for you heaviness, the good news is this should start to fade relatively soon.  It may happen every 3 months or it may not, sometimes slight changes in the botox placement may make a huge difference.  Regards, Dr. Matt Elias

Thank you for your question Tee1965. In addition to its use in addressing wrinkles associated with facial expression, Botox can also be used to address migraine headaches. Heaviness in the brows and/or eyelids is possible after a Botox treatment. Usually these are seen in the first week. It can take up to 4 months for complete resolution. Please follow up with your doctor for specific recommendations. Good luck!