BOTOX® Therapy
Neuromodulator Therapy for Chronic Headaches and Jaw Tension
Neurotoxins, including Botulinum toxin type A (commonly known as BOTOX®, Xeomin®, or Dysport®), are FDA-approved medications used to reduce muscle overactivity and modulate pain transmission.
At Advanced TMJ Maxillofacial Pain & Sleep Center, we use neurotoxins also known as neuromodulators as part of a multimodal approach to managing conditions like chronic migraines, TMD and nerve-related pain. Treatment is provided by an Oral Surgeon and board-certified Orofacial Pain specialist and is available to patients from Seattle, Bellevue, Renton, Issaquah, Federal Way, Puyallup, and beyond.
About Botulinum Toxin (BOTOX®, Xeomin®, or Dysport®)
Neuromodulators block the release of acetylcholine, a neurotransmitter responsible for muscle contraction and pain signaling. Botulinum toxin provides pain relief through both neuromuscular and neuromodulatory effects. In chronic pain conditions like myofascial pain, migraines, and trigeminal neuralgia, it works by targeting peripheral sensitization—a key driver of chronic pain. Botox achieves this is by blocking the release of neuropeptides, including Substance P, glutamate, and calcitonin gene-related peptide (CGRP), from peripheral nociceptive (pain) nerve terminals.
By selectively relaxing hyperactive muscles or reducing nerve irritation, they can:
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Decrease jaw clenching and bruxism
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Relieve muscle tension in the head and neck
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Reduce the frequency and intensity of migraine attacks
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Alleviate neuralgic pain in specific regions (e.g., occipital, trigeminal)
Is there a difference between BOTOX®, Xeomin®, or Dysport®?
All three- Botox®, Xeomin®, and Dysport® are FDA-approved brands of botulinum toxin type A. They work in similar ways by temporarily relaxing overactive muscles and blocking pain-related nerve signals.
While they share many similarities, there are a few key differences:
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Botox® (onabotulinumtoxinA)
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The most widely recognized and studied brand
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FDA-Approved for multiple medical conditions, including chronic migraine
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Contains protective proteins around the active toxin molecule
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Xeomin® (incobotulinumtoxinA)
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Sometimes called the “naked Botox” because it does not have accessory proteins
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This may lower the chance of antibody resistance over long-term use
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Often used interchangeably with Botox in medical setting
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Dysport® (abobotulinumtoxinA)
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Has a slightly different diffusion profile — it can spread a bit more from the injection site
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FDA-Approved for some neurological conditions
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May be preferred in certain treatment areas depending on the clinical goal
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Which One Is Right for You?
The choice between Botox, Xeomin, or Dysport depends on:
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Your diagnosis (e.g., chronic migraine vs. facial pain)
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Insurance coverage (Botox is the most commonly approved for migraines)
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Provider experience and treatment goals
Conditions We Treat with Neuromodulators
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TMJ Disorders – For patients with chronic jaw clenching, hypertrophic masseter or temporalis muscles, or persistent myofascial trigger points.
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Chronic Migraines – Especially for patients experiencing ≥15 headache days per month. FDA-approved protocols are followed for targeted injections across the forehead, temples, neck, and shoulders.
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Tension-Type Headaches – By reducing muscle tightness in the scalp, neck, and shoulders.
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Occipital and Trigeminal Neuralgia – To reduce hypersensitivity and interrupt abnormal pain signaling pathways.
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Post-Traumatic Headaches – As part of a comprehensive recovery plan.
What to Expect from Treatment
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In-office procedure completed in 15–30 minutes
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Minimal discomfort with ultra-fine needles
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Effects begin within 3–10 days and last ~3–4 months
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Gradual improvement with repeated sessions in chronic cases
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Can be combined with physical therapy, splint therapy, and medicationsWho should not receive neuromodulators?
Contraindications include pregnancy, neuromuscular disorders (e.g., myasthenia gravis), allergy to botulinum toxin, or active infection at injection sites.
Evidence-Based Outcomes
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Migraine: FDA-approved for chronic migraine since 2010; studies show up to 50% reduction in migraine days.
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TMD & Myofascial Pain: Meta-analyses and systematic reviews support the use of botulinum toxin for pain reduction and improved function in refractory TMD cases.
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Neuralgia: Clinical reports support targeted use in cases unresponsive to medications or traditional therapies.
Why Choose Advanced TMJ?
Our board-certified orofacial pain specialists offers precision-guided injections based on a thorough diagnosis and tailored to your unique pain profile. Whether used alone or as part of a comprehensive care plan, neuromodulators can be a game-changing therapy for chronic or complex pain conditions
Does my insurance cover BOTOX® Therapy?
The answer depends on why BOTOX® is being used.
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BOTOX for Conditions except TMJ/ TMD: Insurance MAY cover Botox when it is FDA-approved and medically necessary for chronic migraine, dystonias or certain muscle disorders. For chronic migraine, many insurers require documentation of diagnosis and proof that other preventive treatments were tried first. A prior authorization is usually needed.
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BOTOX for TMJ / TMD: Coverage is more limited. BOTOX® for TMJ disorders or orofacial pain is considered off-label. Some insurance companies may review cases individually, but many classify it as investigational and do not cover it. Xeomin can be considered as an off-label alternative for treatment of TMJ disorders.
At Advanced TMJ Maxillofacial Pain & Sleep Center, we help patients by:
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Determining whether their condition may qualify for insurance coverage
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Submitting prior authorization requests when appropriate
Because policies vary widely, the best way to know is to check directly with your insurance carrier. Our team can guide you through this process.
