BOTOX TREATMENT FOR MIGRAINE

Botox Therapy for Chronic Migraine

What is migraine?

• Migraine is a condition, characterized by repeated episodes of headache.
• Headache can be on one side or both sides of head.
• Headache typically lasts for more than four hours, but usually resolves in less than 72 hours.
• Nausea (a sensation to vomit) or vomiting may be present during headache episodes.
• There may be photophobia (headache becomes more in bright light or sunlight) or phonophobia (headache becomes more in noise).

 What is chronic migraine?

A person, who has been suffering from migraine, for a period of more than six months, is said to be suffering from chronic migraine.

What is the impact of chronic migraine on the sufferer?

Chronic migraine leads to a number of problems in the sufferer:

• Recurrent headache interferes with job or studies, leading to poor performance at work or in studies.
• It leads to frequent absenteeism at workplace or in college.
• People suffering from chronic migraine can not enjoy social functions, as slight triggers such as music can trigger the headaches.
• They need to avoid road travel, as it can trigger headaches.
• Patients are frequently forced to take multiple analgesics (pain-killers) every month, leading to significant adverse effects.

What are the treatment options for patients with chronic migraine?

Patients with chronic migraine, who get three or more than three episodes of headache in a month, require preventive therapy (medications to prevent repeated episodes of headache).

What are the commonly used medications to prevent headaches in a migraine patient?

Following medicines (with their brand names) are available for use in chronic migraine:

Tablets

·        Amitryptiline (Tryptomer)

·        Flunarizine (Sibelium)

·        Propranolol (Betacap TR, Ciplar LA)

·        Divalproex (Divaa OD, Dicorate ER)

·        Topiramate (Topamac)

Injections

·        Botulinum toxin (Botox) injections

What are the disadvantages of oral medications?

1.      Lack of efficacy- many people do not adequately respond to these medications. They continue to get recurrent headaches despite taking them for long periods.

2.      Adverse effects- Significant adverse effects are noted with oral medications.

·        Amitryptiline- drowsiness

·        Flunarizine- drowsiness, weight gain

·        Propranolol- aggravation of asthma, depression

·        Divalproex- weight gain, tremors of hands, hair loss, pregnancy-related complications,

·        Topiramate- tingling of feet, weight loss, glaucoma in rare cases, renal stones in rare cases.

 3.      Need to take them on a daily basis

What are the advantages of Botox injections over oral medications in migraine treatment?

1.      Efficacy of botox in migraine has been proven in research and clinical practice.

2.      Botox is fairly safe and the side effects are negligible.

3.      Botox injections need to be repeated once in 3-6 months, so, the patient compliance is better and they can get rid of daily tablets.

Facts regarding Botox injections in a patient with migraine

·        There are fixed points over the scalp, where the injections are given (irrespective of the site of head pain).

·        These locations include front of head, over eyebrows, temple region, back of head and neck muscles.

·        Injections are given by a neurologist, who is trained in the botox procedure.

·        It is given by insulin syringe and needle, and is given in the superficial tissues (scalp muscles, which are hardly a few mm beneath the skin).

·        Topical (surface anesthetic) creams are used, so, the injection does not hurt much and is almost painless.

·        The whole procedure can be completed in an office (Outpatient) set up and is completed in 15-20 minutes.

·        Patient can leave for office or home immediately after the botox procedure.

·        A total dose of 155 units of botox is used in chronic migraine.

Are there any side effects of botox injections?

·        This is the same botox that is used in cosmetic procedures and several million patients have received botox for neurological problems as well (such as writer’s cramp, dystonia, blepharospasm, post-stroke spasticity, hyperhidrosis, etc).

·        It is among the safest injections, and has no serious side effects.

·        Mild pain at the injection site may be felt (just as is felt with any injections).

·        Mild bruising (and redness) and swelling may occur at the injection site.

·        Mild eyelid droop may occur, which improves in a few days on its own.

My experience with Botox in migraine

• I see about 15-20 new cases of migraine per month, and have seen thousands of patients in the past 18 years of my medical practice.
• About 20-30% of them either do not improve with oral preventive tablets or they have side effects with them. Some people find it difficult to take tablets on a daily basis for a long period of time.
• For this group of patients, botox injection therapy is the most ideal. I see 2-3 patients per month, who are eligible to receive botox therapy in chronic migraine. About 1-2 per month receive them. In the past two years, I have given botox to about 40 patients with chronic migraine.
• About 95% patients report benefit after botox therapy and in most cases, oral tablets are not required after botox.
• None of them reported any adverse or side effects with botox.

I would like to share an interesting experience with one of the patients. Mrs Nazia (name changed) from Dubai came in June 2012 for botox therapy in migraine. I gave her the injections on OP basis on the usual sites, including forehead. She had no side effects with botox. She came back for review three months later and reported that she was totally headache-free. However, she wanted a repeat botox injection. I was surprised. I asked her if she has no headache, then why does she want botox! She said, after botox, her husband has started to give her more attention and love, as her face has also improved (then, I realized that she wanted it for cosmetic effects). She also told me that three of her colleagues at her office want the botox to be given by me (but only for cosmetic reasons). I had a tough time, referring them to a cosmetic surgeon for the same.

If you want any further information regarding botox therapy in migraine, please email me at drsudhirkumar@yahoo.com

Dr Sudhir Kumar MD (Medicine) DM (Neurology)

Senior Consultant Neurologist

Apollo Hospitals, Jubilee Hills, Hyderabad

Email: drsudhirkumar@yahoo.com

Phone-0091-40-23607777/60601066