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.