TREATMENT OF CHRONIC MIGRINE WITH BOTULINUM TOXIN
What is chronic migraine?
Migraine is a neurological disease, which presents with headache attacks and other symptoms. Most commonly, an attack lasts 1to 2 days. Seizures occur with severe pain and possible accompanying effects, such as sensitivity to sound and light, nausea or vomiting. Chronic migraine is a headache that occurs 15 or more days per months, meets the criteria of migraine at least 8 days and lasts for more than 3 months.
Treatment of chronic migraine
• Patient training (avoidance of lifestyle and migraine triggers, identification and management of risk factors);
• Treatment of seizures (analgesics and NSAIDs, triptans, neuromodulation, etc.);
• Preventive treatment (topiramate and onabotulin toxin A-BOTOX);
• Non-pharmacological treatment (feedback therapy, cognitive therapy, physical activity, combination of physical activity and feedback);
• Treatment of depression and anxiety.
Research-based efficacy of botulinum toxin
The suitability of botulinum toxin (Botox) for the treatment of chronic migraine is based on the PREEMT study.
The study included 1,384 patients with chronic migraine with an average age of 41 years. These patients experienced headaches for an average of 20 days per month, of which 18 days they had moderate or severe headaches.
The patients to be administered botulinum toxin or placebo were randomised. Those selected for botulinum toxin injection received a fixed product dose every 12 weeks. After 6 months, the number of days of moderate or severe headaches in botulinum toxin-treated patients decreased by an average of 8 days.
After 12 months, 70% of the patients had a reduction in headache of about 50% compared with baseline.
The placebo-treated group experienced a 30% response to the treatments.
What can be expected from the treatment?
It can be expected that after a month headaches will begin to decrease, after the second cycle of injections the number of migraine attacks per month will decrease on an average by 8–9 days, after 3 cycles 70% of the patients will have a 50% or more percentage reduction in the number of days with headache. The shorter the duration of chronic migraine, the faster the treatment effect that may show up after the first injection and become clear after the second administration cycle. If the duration of chronic migraine is long, 3 treatment cycles are needed to assess the effectiveness of treatment.
Botulinum toxin procedure
The procedure is performed while the patient is sitting or lying down. Its duration is about 15 minutes. During the administration itself, there may be momentary slight pain at the puncture site, slight bleeding from the puncture site lasting for a few minutes, and skin swelling in the forehead area, which passes within 10–60 minutes.
The following recommendations should be adhered to after the procedure: Do not lie on your sides and abdomen for 4–6 hours after the injection. Avoid any contact with the injection sites for 12 hours: do not massage, press or rub them, unless your doctor tells you otherwise. For 7–10 days, avoid factors causing the rise in body temperature, such as sauna, hot tubs, solarium, exercises that cause sweating, and sunbathing. When exposed to active sun, use creams with SPF protection and cover the injection sites. Also, avoid massages. When you have an elevated overall body temperature due to colds or other causes, reduce it with right medicines. Avoid taking high doses of B-group vitamins right after the procedure and for a few more weeks (it is also recommended not to take them for a month before the procedure) because this vitamin promotes regenerative processes and may weaken the effects of botulinum toxin.
Complications and contraindications
Since the effects of botulinum toxin manifest gradually over a few days to a few weeks, very rare complications of botulinum toxin can occur after about a week and last for several weeks. The most common of them include neck pain (6.7% of treated patients), neck muscle weakness (5.5%), and eyelid lowering (3.3%). These phenomena are non-hazardous and short-term.
No serious irreversible complications have been observed in the treatment of chronic migraine with botulinum toxin.
Botulinum toxin is not administered if:
• previous history of allergic reactions to botulinum toxin;
• there are diseases of the muscles and peripheral nerves;
• in case of impaired respiratory function, difficulty swallowing;
• coagulation problems (risk of bleeding).
Botulinum toxin injections should not be performed during pregnancy or breast-feeding.
Is this a treatment that would suit me?
Botulinum toxin (BOTOX) treatment is now the most effective treatment for chronic migraine.
Whether it would suit you should be assessed by a neurologist, a headache specialist.