BOTOX® as a treatment for migraine

BOTOX® (onabotulinumtoxin A) is offered as a treatment for migraine headaches. BOTOX® extends the possible treatment options for patients with chronic migraine and is as equally effective as Topiramate – approximately 40% of patients achieve a 50% reduction in headache days with either treatment. BOTOX®, however, was better tolerated in trials with fewer patients discontinuing treatment due to adverse events than those in the Topiramate group.

Once deemed as a candidate for the treatment, there is a visit to the clinic where injections are given in each of 31 sites on the scalp and neck. The needle is very small and generally patients tolerate the procedure well. Patients are asked to remain in the waiting area for about 30 minutes to ensure that they feel well enough to return home. If the injections have a positive effect they can be given every three months and the treatment usually starts with two courses to see how well patients respond to the treatment.

Treatments for Migraine are available at The Horder Centre from Dr Gerry Saldanha.

Types of Migraine

Migraine without aura – headache of moderate to severe intensity, which may start on one side of the head. The headache is often throbbing in quality and may be associated with nausea, intolerance of light and loud noises and hypersensitivity to odours. The headache may last four to 72 hours and is usually exacerbated by routine activity.

Migraine with aura – has the features of migraine without aura but is accompanied by transient neurological symptoms which can include blind spots, seeing zigzag patterns and flashing lights, numb feeling, pins and needles and prickly skin; these develop gradually over 30 minutes and last up to 60 minutes. The aura symptoms generally precede the headache by up to 60 minutes and rarely the headache may be absent (known as acephalgic migraine).

Chronic Migraines – Chronic Migraine (CM) best characterises those patients with a history of migraine who experience headaches more often than not – excluding patients who have daily headache due to medication overuse. Initial treatment options for CM focus on triggers such as changes in diet, sleep, exercise, and psychological stressors, in addition to many other potential influencing factors. Caffeine, alcohol, tobacco, and use of select over-the-counter and prescription medications should be minimised due to their potential for increasing headache episodes.

Treatment options

Acute treatment options include simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDS), Triptans, and less commonly ergotamine preparations. Patients are advised to limit doses to two or fewer days per week to minimise the risk of rebound headache. Headache preventative medications include antidepressants, anticonvulsants, beta-blockers, calcium channel blockers and potentially BOTOX® injections. Patients starting new preventive therapy should keep in mind that it may take several weeks for full treatment effects to occur.

Patients who may benefit from BOTOX®

BOTOX® treatment is available to patients with chronic migraine where other pharmacological treatments have failed or had limited benefit. Prospective patients will be assessed by Dr Saldanha and careful consideration given to their suitability for this treatment. It may not be suitable for all patients with chronic migraine. Dr Saldanha is now offering private appointments at The Horder Centre. If you would like to consider BOTOX® as a treatment option, you must seek a private referral from your GP addressed to Dr Saldanha at Horder Healthcare.

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