Botox® — the renowned wrinkle smoother — is proving its value as a headache soother. FDA-approved in 2010 for treating chronic migraines in adults, Botox (onabotulinumtoxinA) is offering new hope for the estimated 14 million Americans who suffer from chronic migraine1 – and for whom all other treatment options have failed.
“Chronic migraine is defined as debilitating headaches that have gone on for at least three months, occurring at least 15 days per month, and lasting four or more hours each of those days,” explains Cooper Neurological Institute neurologist Larisa Syrow, MD.
“A certain percentage of patients have intractable migraines,” she continues. “They’re feeling hopeless and so are their physicians, since they’ve tried so many treatments and nothing is helping. Botox gives them a really good chance for improvement.”
The FDA’s approval of Botox for use in treating chronic migraine was based on results from two studies that reported patients treated with it experienced a major decrease in the frequency of headache days.
“These original reports, however, don’t sound as impressive as the results I’m seeing in practice,” Dr. Syrow says. “Many patients experience a
radical improvement in the frequency and severity of their migraines.”
Treatment — administered every 12 weeks — entails a total of 31 injections into muscles in several areas in the forehead, the sides and back of the head, neck and shoulders, pro-effects – as with any injection – include a chance of localized bleeding, infection or soreness at the injection site. There also is a small possibility of asymmetric forehead and other temporary cosmetic effects. More serious side effects are extremely rare. Pregnancy is the only significant contraindication for this preventive treatment.
Importantly, most insurers cover Botox treatment when it’s documented that the patient meets the criteria for chronic migraine and that multiple other treatment modalities have failed.
“I’m not just the procedure lady,” she stresses. “I’ll do a comprehensive evaluation and if I don’t think Botox is the right approach, I won’t administer it. Sometimes it’s not a matter of medications at all but lifestyle modifications, such as diet and stress management.
“Botox prevents the vesicle where acetylcholine is stored from binding to the membrane where the neurotransmitter can be released. This blocks the release of acetylcholine by theneuron, effectively weakening the muscle for up to three months.”
“Botox prevents the vesicle where acetylcholine is stored from binding to the membrane where the neurotransmitter can be released,” Dr. Syrow explains. “This blocks the release of acetylcholine by the neuron, effectively weakening the muscle for up to three months.”
She also notes that Botox has fewer side effects and contraindications than other medications prescribed to treat chronic migraine. The most common side effects – as with any injection – include a chance of localized bleeding, infection or soreness at the injection site. There also is a small possibility of asymmetric forehead and other temporary cosmetic effects. More serious side effects are extremely rare. Pregnancy is the only significant contraindication for this preventive treatment.
“Botox prevents the vesicle where acetylcholine is stored from binding to the membrane where the neurotransmitter can be released. This blocks the release of acetylcholine by the neuron, effectively weakening he muscle for up to three months.”
Importantly, most insurers cover Botox treatment when it’s documented that the patient meets the criteria for chronic migraine and that multiple other treatment modalities have failed.
While Botox is relatively expensive — insurers are covering it because the alternatives, such as going to the emergency room or taking tons of medications, are no less expensive,” Dr. Syrow notes. “And if it helps patients prevent their migraines, it’s a small price to pay.”
If you have a patient with intractable chronic migraine headaches who has exhausted other treatment options, you are encouraged to refer him or her (the majority of migraine sufferers are women) to Dr. Syrow for evaluation.
“I’m not just the procedure lady,” she stresses. “I’ll do a comprehensive evaluation and if I don’t think Botox is the right approach, I won’t administer it. Sometimes it’s not a matter of medications at all but lifestyle modifications, such as diet and stress management. I’ll talk about these options with the patient, if appropriate.
“But if Botox injections are indicated, we can provide them,” she continues. “If nothing else has worked, it’s well worth trying. It’s important for patients — and their doctors — to know that there’s hope.”