What is a migraine?
Migraine is a common and debilitating disorder of repetitive headaches.
A migraine differs from other headaches in a few key ways. A migraine usually involves pain over one side of the head, an ‘aura’ or sensation over the body prior to the migraine arriving, nausea and associated visual or smell disturbances. It can last a few, to several hours for some patients.
What are the causes of migraine?
Migraine has many associated risk factors. It is linked to triggers such as alcohol, hormonal changes, stress, sleep deprivation and is thought to involve blood vessel calibre changes however may also involve the muscles surrounding the cranial vault. The exact cause in each case is not always found.
Similarly, there is much overlap with tension headaches and those related to bruxism or jaw grinding. Many people grind their teeth at night, leading to sore muscles around the head and face. Stress is a factor, as are dental issues.
How can a migraine be treated?
Migraines are treated first by minimising triggers such as caffeine, alcohol, sleep deprivation and optimising health. Following this, medications such as triptans, beta blockers or topiramate can be used if migraines are especially frequent and interrupt life. Following this, botulinum toxin can be injected for severe cases.
What is Botulinum toxin?
Botulinum toxin is also known commercially as Botox or sometimes Siax. It is a poison from a kind of bacteria. It has the ability to stop the nerves from sending a signal to contract our muscles and in effect, paralysis muscles.
Research has looked at Onabotulinim A which is in Botox. Studies have shown a positive effect, matching that of tablet medication. There is an effect on chronic headaches as well. A 2018 cochrane review was focused on migraine showing an effect.
Where is it injected and how much?
Many doctors will employ the PREEMPT method of injecting botox in 5 units doses at 31 sites. Generally this involves the principle of injecting into the most painful sites identified by the patient and by palpation.
(*We need to create another graphic for this or steal one etc.)
What are the side effects?
All botulinum toxin has the potential to inadvertently paralyse the wrong muscle. This may mean that the eyes or lips could droop, however your practitioner will take every caution against this. After botulinum toxin, some people feel a small headache as the muscles that have been contracting so long reduce their strength and other muscles
may engage. Some people have bruising and pain which is mild and usually settles on its own
How long will the injections last?
About 12 weeks until the next dose is required; however all patients should be guided based on their experiences.
REFERENCES
Blumenfeld A, Silberstein SD, Dodick DW, Aurora SK, Turkel CC, Binder WJ. Method of injection of onabotulinumtoxinA for chronic migraine: a safe, well-tolerated, and effective treatment paradigm based on the PREEMPT clinical program. Headache. 2010;50(9):1406-1418. doi:10.1111/j.1526- 4610.2010.01766.x
Escher CM, Paracka L, Dressler D, Kollewe K. Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Ther Adv Neurol Disord. 2017;10(2):127-135. doi:10.1177/1756285616677005
Gaul C, Holle-Lee D, Straube A. Botulinumtoxin A in der
Kopfschmerztherapie : Bewährte und experimentelle Indikationen [Botulinum toxin type A in headache treatment : Established and experimental indications]. Nervenarzt. 2016;87(8):853-859. doi:10.1007/s00115-016-0138- 5
Herd CP, Tomlinson CL, Rick C, et al. Botulinum toxins for the prevention of migraine in adults. Cochrane Database Syst Rev. 2018;6(6):CD011616. Published 2018 Jun 25. doi:10.1002/14651858.CD011616.pub2
