Saturday, January 28, 2023 Jan 28, 2023
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Headache’s Gone and My Skin Is Smooth

Dr. Jeffrey Janis uses Botox to treat migraines.
By Rod Davis |
photography by Jeremy Sharp

Dr. Jeffrey Janis probably hates that headline, but when you’re using Botox to treat migraine headaches, you have to expect a few raised eyebrows. This is, after all, the wonder drug of the vain. But some plastic surgeons, such as Janis, assistant professor of plastic surgery at UT Southwestern Medical Center, have long known that the wrinkle remover has legitimate medical uses. About five years ago, Janis began following a correlation between Botox and migraines accidentally discovered by a colleague, Dr. Bahman Guyuron of Case Western Reserve University in Cleveland, during routine surgery for brow lifts.

Through subsequent anatomical studies, duly published in professional journals, Janis and Guyuron demonstrated that the Botox injections at key locations in the forehead and scalp could effectively isolate the nerves—typically above the eyebrows—that act as headache triggers. Janis, who is also chief of plastic surgery for Parkland Hospital, identified four “trigger points,” from the forehead to the neck, ideal for the injections that in turn paralyze the muscles that compress and irritate nerves. Based on four to five years of clinical use, Botox injections temporarily eliminate migraines in about 80 percent of Janis’ patients. Follow-up surgery, which is the actual treatment, is effective in approximately 85 to 90 percent of cases.

As the only plastic surgeon in Dallas who does the procedure, and one of only about 10 in the entire country (although more doctors, including neurologists, are warming to the treatment), Janis has labored in relative obscurity. Botox-migraine patients have comprised only about 15 percent of his practice. No longer. He says, “This thing has just exploded. The amount of patients I have seen has really gone through the roof.” Still, it’s a big roof: migraines affect 28 million Americans, 75 percent of them female. “I’ll bet you everybody knows somebody that has had migraines,” Janis says. It’s a good bet that the ones in Dallas are spreading the word about what could be the hottest use yet of a drug that can do a lot more than make you look young.

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