If you need a more accessible version of this website, click this button on the right.Switch to Accessible Site

Marshall James Nev, PLC | Botox for Pain in Richmond

Lexington-Richmond Headache Clinic
Marshall James Ney, DMD, FAAOP
Fellow American Academy of Oral Facial Pain

527 W. Main St.
Richmond, 40475
(859) 623-3761

Botox for Pain


botox_illustration.jpgBefore you read any further, a word of caution. Botox/Myobloc injections for pain are almost always near the bottom of the headache treatment list. Why? Several reasons:

  1. They are very expensive. One round of treatment can cost $1,500 or more. And many insurance companies will not pay for it unless you have explored other treatment protocols. Quite frankly, (and you won’t find me agreeing with Insurance companies often) I believe they are right.
  2. Botox/Myoblock injections weaken the muscle. In some cases this is good, but in most it is not good. As you may have seen with our clinic's approach, strengthening your neck muscles can help you manage your headache pain.
  3. Botox works by paralyzing parts of the muscle, which inherently makes the muscle weaker. Once part of the muscle is paralyzed, you cannot strengthen it.

Learn More

Let me tell you two stories about different patients and their experience with Botox.


The first patient is Linda. She was a VA patient back from Iraq, with constant cervical pain. The VA was giving her Botox injections into the back of her neck every three months. It controlled the pain, but she was unable to hold her head up. She had almost no muscle strength to move her head forward.

What could we do absolutely nothing. She would have had to go off of the Botox, go back into pain, have us help her manage her pain as we would any new patient, and then get her into physical therapy so she could begin to strengthen her neck muscles. This was not acceptable to her. Quite frankly, I don’t know if it would have been acceptable to me.

The way the Botox was used was entirely wrong for this patient. It made her dependent on the Botox and made longer lasting conventional treatment without medication almost impossible to implement.

The area of pain that she experienced is shown in the picture below.



Now let me tell you a story about how to appropriately use Botox for pain. Some humor in included since, without it, Sue's story is tragic.

Sue came to our clinic with her daughter Tink. She had some dental work done and returned to take care of some problems. She was looking somewhat down. Her daughter Tink and husband Jeffery are friends of mine.

Jim: Sue, you do not look to chipper this morning.
Sue: Well, I have a headache.
Jim: How long have you had it?
Sue (looking at floor): About 74 years!
Tink (nodding in agreement): Yes that’s right.
Jim: You mean she has had a headache for the last 74 years?
Tink: Yes.
Sue: Yes.
Jim: Good grief, Charlie Brown.

The muscles that were involved with Sue did not require strength. They were, however, muscles that were involved in stress, 74 years of stress, to be sure. The pain caused stress and then the stress caused more pain. It was a never ending circle that no one had tried to break.

I injected Marcaine (local anesthetic) into the trigger points of the Occipital Frontalis muscle and Sue's 74-year headache was completely gone.


The amazing part of this story is that Sue’s husband and Tink’s father died at an early age and Sue still managed to be a great mother (according to both of her girls).

So, what did we do? It turns out that the Occipital Frontalis muscle does not move anything but the scalp and forehead muscles, so we did not have to worry about strength.

We gave Sue Botox injections that day, then 3 months later, then 5 months later, then 1 year later. I have not given her a Botox injection now for over 2 years.

Some Technical Stuff

If you like technical stuff you can read further about Botox and Myoblock.

Botulinum Toxin Injections (Botox or Myoblock Injections)

What is Botulinum Toxin? What are the uses for Botulinum Toxin?

Botulinum Toxin is a substance made by the bacteria Clostridium botulinum, the same bacteria that can cause botulism. This may sound alarming; however, the substance made for medical use is an inactive form of the toxin several thousand times less potent than that needed to cause botulism.

There are several toxins produced by the bacterium Clostridium botulinum. Botox is a Type A strain, while the newer Myobloc is a Type B strain. Although Botox and Myobloc have different mechanisms of action they both effectively reduce painful muscle spasm. Gradual relaxation of muscle spasm develops over one to two weeks after the injection of either agent. The reduction of muscle spasm lasts for 3-4 months and pain relief can last even longer. Conditions that are treated with Botox botulinum injections (Botox or Myobloc) include muscle contraction headaches, chronic muscle spasms in the neck and back, torticolis (severe neck muscle spasms), myofascial pain syndrome, and spasticity from multiple sclerosis or stroke.

—Dr. Ney


Richmond Dentist | Botox for Pain. Marshall James Ney is a Richmond Dentist.