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WILDERMAN MEDICAL CLINIC
Botulinum toxin for migraine
Migraines are relatively common and often debilitating. The symptoms of a migraine condition can affect a person’s ability to perform day-to-day activities and considerably diminish the quality of life; because of this, finding an effective treatment for migraines is imperative.
It is important, when seeking treatment, to understand the difference between migraines and other headaches. According to the Cleveland Clinic, there are over 150 different types of headaches.
Headaches are characterized by various uncomfortable sensations in the head, ranging from aches and pressure to severe, sharp pains. Headaches can result from various causes, including stress, muscle pain, and sinus infections, to name a few.
Migraines, on the other hand, often have symptoms in addition to head pain, such as nausea/vomiting, visual disturbances, pain in the eyes, ears, or temples, and changes in sensation (such as numbness/tingling, changes in taste and smell, ringing in the ears, or even changes in speech).
Unlike headaches, migraines often involve only one side of the head, although the pain may encompass both sides.
The severity of pain with migraines is also typically more intense than with headaches, occasionally leading the sufferer to seek out medical assistance in a hospital emergency department. A thorough medical history is required in order to diagnose a migraine.
What causes migraines?
Various factors can influence the development of migraines, including:
• Genetics (a family history of migraines)
• Gender – more frequent in women (possibly due to hormonal influences, such as birth control medications or menopause)
• Anxiety or stress
• Lifestyle factors, such as smoking, alcohol consumption, poor dietary habits (like missing meals), excessive caffeine consumption, food or chemical sensitivities, poor sleep, and dehydration.
• Environmental factors (changes in barometric pressure, loud noises, exposure to certain chemicals or irritants, certain medications)
What are the standard treatments for migraines?
Typically, a preventative approach is taken to the treatment of migraines. Some methods that are recommended include:
• Lifestyle changes, such as reducing caffeine and alcohol, eliminating possible trigger foods, and improving sleep hygiene
• Improving stress management
• Certain prescription medications
Some medications may also be recommended to manage migraine symptoms, should one occur, such as nausea and pain medications.
If the above-mentioned methods or this manual physiotherapy and its various techniques do not sufficiently relieve the symptoms, onabotulinumtoxinA (Botox) may be a good option.
What is Botox?
OnabotulinumtoxinA, or Botox, is a neurotoxin that, in small doses, can be safely used to treat numerous conditions, including migraines.
Current studies have shown that migraine sufferers consistently report a significant reduction in the frequency of migraines with Botox treatment; the effect is thought to be due to Botox blocking chemical messengers (called neurotransmitters) transmitting pain signals to certain nerve endings.
Who is a good candidate for Botox treatments?
In order to qualify for this treatment, your healthcare provider will take an extensive medical history to rule out any other causes of the migraine symptoms and to definitively diagnose a migraine condition.
Additionally, you must have headache symptoms for more than half of the days of the month and some of them lasting for 4 hours or more at a time.
Typically, patients try several oral medications to prevent migraine before deciding to get Botox injections.
What can I expect during my procedure?
Following a consultation with your healthcare provider, multiple Botox injections will be administered in the head and neck area.
At Wilderman Medical Clinic (WMC), we follow the PREEMPT protocol, which established efficacy in clinical trials.
The total number and location of these injections will be determined based on your unique symptoms.
How quickly will I see results and how long will they last?
Botox treatments typically take from 3 to 14 days to take effect.
Treatment will then have to be repeated approximately every three months (10-12 weeks) in order to maintain ongoing results.
Are there any risks or side effects?
As with any medical intervention, there are certain risks and possible side effects.
Common side effects include temporary redness, swelling, and tenderness at the site of the injections, fatigue, neck pain, chills, and dry mouth. Rare, but serious side effects include an allergic reaction; the symptoms of an allergic reaction include shortness of breath or difficulty breathing, edema, and hives.
In the case of an allergic reaction, medical attention should be sought immediately.
Is there scientific research to support this treatment?
A study, published in February 2017 in the Therapeutic Advances in Neurological Disorders journal, concluded that “there is good clinical evidence that treatment with onabotulinumtoxinA leads to a reduction of monthly headache days and improves quality of life.”
More recently, Dr. Igor Wilderman (the director of WMC) and his associates published an article in the Journal Pain and Therapy entitled A Qualitative Study to explore patient perspectives of Prophylactic Treatment with OnabotulinumtoxinA for Chronic Migraine; this study explored the patient perception of Botox treatments for migraines and the factors that encourage or deter patients from seeking this type of treatment.
The WMC staff endeavors to stay abreast of the current research, including performing studies in our own clinical trials department, to provide patients with the safest, most effective treatments possible.
Works Cited
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
Migraine Headaches. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches.
Weatherspoon, Deborah. August 10, 2020. What’s the difference between migraine and headaches? Retrieved from https://www.healthline.com/health/migraine/migraine-vs-headache#_noHeaderPrefixedContent.
Wilderman I, Tallarigo D, Pugacheva-Zingerman O. A Qualitative Study to Explore Patient Perspectives of Prophylactic Treatment with OnabotulinumtoxinA for Chronic Migraine. Pain Ther. 2021 Dec;10(2):1523-1536. doi: 10.1007/s40122-021-00316-2. Epub 2021 Sep 14. PMID: 34523107; PMCID: PMC8586057.
