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24th Annual Pain Medicine Meeting 2025
November 13-15, 2025| JW Marriott Austin, Austin, Texas
2193108
Assessing the Role of Masseter Botulinum Toxin Injections in Chronic Migraine: A retrospective single clinic observational study
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Scientific Abstracts > Case Series
Patients with chronic migraines have a high prevalence of myofascial pain which may contribute to migraine attacksOf these patients, many specify the masseter muscles as sources of myofascial pain.Masseter BoTN/A has been studied in myofascial pain in temporomandibular disorders, but not in chronic migraine.This study assesses masseter BoTN/A in chronic migraine with masseter pain.
•Retrospective case series at a tertiary headache and pain clinic.
•Patients receiving BoTN/A for migraines who described myofascial pain of the masseters contributing to their headaches received BoTN/A in the bilateral masseters over one year were included.
•Response to therapy was obtained from review of clinic notes, including numeric rating scale, percentage improvement, as well as decrease in headache and migraine days.
•170 chronic migraine charts reviewed;
•30 (17.6%) patients reported myofascial pain in the masseters as an active contributor to migraine attacks and agreed to bilateral masseter BoTN/A injections
•Patients an average of 12U per side, range 5-20U.
•28/30 patients had received BoTN/A in the masseters multiple times prior to the study period.
•30/30 reported reduced headache frequency and/or intensity and requested repeat masseter injections.
•No adverse effects reported.
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•The muscle was palpated with the patient biting down.
•5U were injected per target site. Those who got 20U had 4 injections within the muscle about 0.5cm to 1cm apart
•The posterior border of the masseter was avoided to remain anterior of the parotid gland.
•The inferior portion was avoided due to remain superior to the marginal mandibular nerve.
•Masseter BoTN/A injections may be beneficial in reducing the frequency and severity of migraine attacks in chronic migraine patients reporting myofascial pain in the masseters.
•Findings support further research into masseter-targeted BoTN/A in those with myofascial TMD and chronic management.
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