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Pain Receptors in the Bone, Skull & Scalp Pain, and Botox

Headache specialist Christina Peterson‘s comments on the news that a patient’s skin sensitivity may help predict Botox’s effectiveness for migraine explains the exciting research behind the story. Dr. Peterson attended the lecture on the topic at the International Headache Society’s annual conference. She wrote:

This was far and away the coolest lecture, although it was also given at the American Headache Society Meeting. Dr. Rami Burstein, who is a basic science researcher at Harvard, has done some ground-breaking research.

It has been conventional wisdom that there are no pain receptors within bone; the only pain receptors are on the periosteum–the lining on the bone. Dr. Burstein took it into his head to wonder if this were actually true of the skull, and set out to trace the pain pathways in rats. He showed amazing slides of fluorescent lime green nerve fibers shooting right through holes in the bone of the skull (so, yes, your skull can hurt), and terminating at the hair follicle.

So–when people say they have headaches that feel as if their hair hurts, it can be literally true. These nerve fibers were most dense at the sutures in the skull, where the bony plates of the skull come together. And now we know why craniosacral therapy works!

Dr. Burstein has also determined that there are three major types of headache pain:

  • Explosive pain (like you feel as if your brain is too big and will explode out of your head)
  • Implosive pain (as if your head will cave in the pressure is so great)
  • Orbital/eye pain (your eye hurts, or it hurts behind your eye, or it hurts to move your eye)

Unfortunately, you are permitted to have more than one of these in a given headache. He has found that it is the implosive type of pain that is most likely to respond to Botox. [all emphasis mine]

Dr. Peterson’s latest e-mail newsletter, which arrived in my inbox today, explains more about the research. If you aren’t subscribed to the newsletter, you’re missing out on an excellent, up-to-date resource. Take a look at previous newsletters and sign up for future issues.

5 Responses to Pain Receptors in the Bone, Skull & Scalp Pain, and Botox

  1. Joanna says:

    Very interesting… I went through about 3 rounds of Botox for my headaches. To no avail, of course, but I have heard success stories. My pain changes, but one of the most frequent types is a vice-like feeling.

    *******
    I did three rounds of Botox without success too — I’m sorry it didn’t work for you either.

    Have you been diagnosed with migraine or some other sort of headache disorder? I’m curious about the “vice-like” pain you describe.

    Take care,
    Kerrie

  2. WOW! This is really fascinating. I am so impressed with doctors who question Gray’s Anatomy and its progeny, rather than shrugging and saying, “This is how it’s always been done” or “This is what we already know” … what an exciting development in this research body.

    Dr. Burstein gets major credit here, Kerrie, but I personally believe you’re going to be the one to ultimately find the cure to chronic headaches!

    ********
    Thanks for the vote of confidence!

    Kerrie

  3. Will Morse says:

    I did quite a few rounds of botox for headache treatment. I wouldn’t say it was a miracle cure but it really did suppress the worst of the headache symptoms. Each treatment lasted for 3 or 4 months. I also tried a few rounds of lidocaine, with more mixed results.

    Interestingly, I started doing it about the time I discovered trigger points, and we injected botox into the worst trigger points in the trapezius. That really helped, and had a much bigger effect than facial injections.

    *******
    I’m glad it helped you some. Have you stopped having the Botox treatments?

    Interesting about trigger points in your trapezius. There’s a lot more to Botox than research shows.

    Kerrie

  4. Jackie Delgardio says:

    I had pain in the left side of the back of my skull and on top of my head, toward the front. I have had anesthesia injected into the left side of my skull in the back. I had my worst pain last night into my ear with blurred vision. I am trying to get my ins. co. to pay for botox injections. I had natural childbirth and I can tell you that this pain is worse. I had three episodes in a 24 hour period. I would like to hear fron others, because I feel so alone. Jackie Blue.

    *******
    I’m sorry you’re suffering so much, Jackie. You’re definitely not alone. Your best bet for hearing from others is to visit the online support group and forum: http://www.thedailyheadache.com/forum/

    Take care,
    Kerrie

  5. Steve McAbee says:

    I have been suffering from head pain very similar to Jackie Blue. Three episodes over the last four years, each episode lasting 2-3 months. I have several onsets each day, with the pain always starting at a distinct point on the left side, rear of the skull. It branches out from there, forward over the top of my skull toward my left eye, and down the left side of my neck where it causes my neck to spasm and popping of the vertebrae. It seems like certain positions of the head and neck have effect on the pain. They have been treating it with anti-inflammatory drugs, I have not found any relief yet. I have not been able to work as activity makes it worse. My doctors do not seem to have any kind of a grip on it (I’m working my way up the chain from a chiropractor, to a GP to a neurologist to ??) I’ve been relatively healthy all of my 61 years and now, having to deal with this pain everyday, well, it has had a drastic effect on my life and my wifes life too. I am just now beginning to realize that there may not be a answer, or any end to my pain. I’m in my third month of this episode, with no let-up in sight.

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