{"id":542,"date":"2015-09-24T16:13:17","date_gmt":"2015-09-24T23:13:17","guid":{"rendered":"http:\/\/dentox.com\/botox-edu-news\/?p=542"},"modified":"2015-09-01T16:31:55","modified_gmt":"2015-09-01T23:31:55","slug":"botox-effective-at-treating-chronic-migraine","status":"publish","type":"post","link":"https:\/\/dentox.com\/botox-edu-news\/botox-effective-at-treating-chronic-migraine\/","title":{"rendered":"Botox: Effective at Treating Chronic Migraine"},"content":{"rendered":"<p><img fetchpriority=\"high\" decoding=\"async\" class=\"alignleft size-medium wp-image-513\" src=\"https:\/\/dentox.com\/botox-edu-news\/wp-content\/uploads\/2015\/04\/depressed-300x200.jpg\" alt=\"depressed\" width=\"300\" height=\"200\" srcset=\"https:\/\/dentox.com\/botox-edu-news\/wp-content\/uploads\/2015\/04\/depressed-300x200.jpg 300w, https:\/\/dentox.com\/botox-edu-news\/wp-content\/uploads\/2015\/04\/depressed-380x254.jpg 380w, https:\/\/dentox.com\/botox-edu-news\/wp-content\/uploads\/2015\/04\/depressed.jpg 424w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><span style=\"font-weight: 400;\">While there have as yet been no double-blind, placebo-controlled studies proving the effectiveness of Botox as a treatment for severe chronic migraine, Botox may well be one of the best preventive treatments for severe chronic migraine sufferers. \u00a0This opinion is based on a number of small controlled trials combined with a large number of anecdotal reports, and extensive clinical observation.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A person with chronic migraines is defined as having headaches at least 15 days out of the month, with actual migraine symptoms at least 8 days a month. \u00a0In one clinic, over the course of 13 years, nearly 2,000 patients were treated with Botox, and it is estimated that, of those, 60-70% got relief from Botox. \u00a0Many of those had tried multiple other therapies to no avail.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">One of these patients was a 76 year old woman who had endured migraines for 60 years. \u00a0After dozens of different medications, nerve blocks, and other therapies, she saw a neurologist, who recommended Botox. \u00a0After a single treatment, she experienced three months of total relief from her migraines.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">One of the most interesting things about Botox is that it is quite safe. \u00a0This is probably due to the fact that it is a local injection, rather than a systemic treatment like medication, and that it is used in minute doses. \u00a0Botox is used for so many different conditions that it has been used in millions of times in the past 20 years. \u00a0Botox is a bit pricy, but studies have shown that it actually reduces healthcare costs in migraine patients, not to mention the costs attributed to time off work and reduced productivity.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Recent reports have raised concerns regarding FDA review of the safety of Botox. \u00a0It is important to note that the safety issues were related to two very specific groups of patients. \u00a0The first group was children with cerebral palsy who received Botox to treat spasticity. \u00a0There is a concern that they could receive too many doses leading to system toxicity. \u00a0The second group of concern is patients who were treated with Botox for torticollis, a condition where tightened or spastic neck muscles prevent normal head movement, who developed trouble swallowing.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There was also a case of an unlicensed practitioner who injected himself and three others with a dose 3,000 times higher than normal with commercial grade botulinum toxin. \u00a0All victims spent several months on a respirator, but ultimately recovered. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Though generally safe, Botox is just like any other drug in that it does carry some risk of side effects. \u00a0Most side effects are temporary and usually mild. \u00a0These include worsening of pain immediately after the injections, bruising, redness, and undesirable cosmetic outcomes (such as mismatched eyebrow height). \u00a0Injections in the trapezius muscles can lead to a collapsed lung, and injections in the neck muscles can cause weakness requiring a soft collar temporarily. \u00a0Most side effects, especially the more serious ones, are generally avoidable through proper technique.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">While it is possible to have an allergic reaction to Botox, severe reactions are extremely rare, probably because the dosage is so minute. \u00a0The typical dose for treating headaches is only 5 nanograms, or 5 billionths of a gram. \u00a0For those not familiar with the metric system, there are more than 28 billion nanograms in an ounce.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Myobloc, another botulinum toxin product, is available, but with some disadvantages. \u00a0It has a very low pH (is quite acidic), so injections are more painful. \u00a0It takes effect a little faster, but doesn\u2019t last quite as long as Botox. \u00a0The risk of it spreading beyond the treated area is also higher, increasing the risk of muscle weakness near the treated area. \u00a0Despite the disadvantages, in those rare instances when a patient develops antibodies to Botox, Myobloc may still be effective.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It is important that Botox only be used in patients who have undergone thorough evaluation. \u00a0It is important to rule out factors that may be contributing to headaches, such as too much caffeine, too little magnesium, or hypothyroidism, as eliminating contributing factors may be sufficient to offer relief. \u00a0Then, triptans or other therapies, including medication, exercise, nutrition, and supplements should be tried. \u00a0Anticonvulsant medication or a \u03b2-blocker may also be considered prior to Botox.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Botox has not been approved for use in women who are pregnant or breastfeeding, but is appears to be safer than many other migraine medications, many of which are also not approved. \u00a0Just because it isn\u2019t approved does not mean pregnant women cannot receive Botox. \u00a0Many have, and with excellent results.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">After so many years of using Botox for so many different conditions, why have there not been more studies to prove the safety and efficacy of Botox? \u00a0There are a couple of reasons. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">One of the biggest reasons is the difficulty in conducting double-blind trials of injectable medications because placebos produce a response so frequently. \u00a0While there have been a number of small trials that support the efficacy of Botox in treating chronic migraines, large studies have failed to reduce the number of headache free days. \u00a0However, when patients using prophylactic medications are eliminated, the difference becomes more significant. \u00a0This difference clarifies why it is important to exclude patients on prophylactic medications from migraine trials.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Another trial was poorly designed because the injections were only given in the front of the head. \u00a0In that study, patients given 25 units of Botox showed improvement, while those receiving 75 units did not. \u00a0It is possible that patients with strictly frontal headaches were more concentrated in the lower dose group than in the higher dose group.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Two other medications, topiramate (Topamax) and gabapentin (Neurontin), have proven moderately effective, but have not received FDA approval for migraine treatment. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There is some concern that Botox has become a popular treatment due to higher reimbursement rates by insurance companies than some other treatments. \u00a0While a valid concern, nerve blocks are also reimbursed at a high rate, without gaining the popularity that Botox has achieved.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Another round of trials in progress will hopefully persuade the FDA of the safety and efficacy of Botox for chronic migraines. \u00a0<\/span><\/p>\n<p><b><a href=\"https:\/\/dentox.com\/all-courses\/botox-training\/\">About our course for Botox Injection Training<\/a>.<\/b><\/p>\n","protected":false},"excerpt":{"rendered":"<p>While there have as yet been no double-blind, placebo-controlled studies proving the effectiveness of Botox as a treatment for severe chronic migraine, Botox may well be one of the best preventive treatments for severe chronic migraine sufferers. \u00a0This opinion is based on a 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