Migraine
A new, innovative treatment is now available with Dr Santa Cruz at ‘the gentle dentist’ for chronic migraine sufferers.
Botox, commonly associated with use in cosmetic treatments to temporarily freeze facial muscles and improve the appearance of frown lines and wrinkles, is approved for use in treating patients suffering from migraine.
Doctors know that injections of Botox can help smooth wrinkles because it relaxes muscles in the face.
Botulinum gets into nerve endings and stops the nerve being able to respond normally to an electrical nerve impulse and, whatever that nerve normally does, stops working.
So, when facial expression muscles are injected, facial wrinkles are reduced and the transmission of pain through the nerve fibres in the area which is injected is blocked.
It was noticed by chance many years ago that people having cosmetic botulinum injections had fewer headaches.
Because of this, doctors began to study it as a migraine pain treatment.
This research proved that Botox worked for chronic migraine.
Botox has proved significantly more effective than a placebo in reducing headache frequency.
In clinical studies of more than 1,300 patients, nearly half of patients (47%) who received Botox reported a 50% or higher decrease in headache days by 24 weeks following treatment.
As well as a notable reduction in the frequency of attacks, patients also report decreased severity and duration of migraines after treatment.
It is also now used to treat other illnesses including hemifacial spasm, dystonia, cerebral palsy, and stroke.
Am I suitable for this treatment?
If you suffer from chronic migraines (i.e. you have headaches for more than 15 days in a two to three month-period or more than four severe attacks a month) then you may be suitable for this treatment.
What does the treatment involve?
Patients will need an initial consultation to assess their suitability for this treatment.
If appropriate, patients can be treated at the same appointment.
Injections may be recommended every three months initially, but the frequency of treatments should decrease over time until perhaps yearly treatment is enough.
How does it work in migraine?
It is thought that botulinum toxin gets into the small nerves that carry pain from the head to the brain, known as C-fibres. This reduces the amount of chemicals released from the nerve ending and therefore interrupts the feedback pathway that perpetuates migraine and headache.
How is it given?
BOTOX ® is given as a series of injections under the skin or into the muscles in and around the head and the forehead, above the ears, and into the neck and shoulders. The injections are repeated every 12 weeks until the patient no longer has chronic migraine, or until it is clear that treatment is not working. Normally a response is seen after the first or second set of injections.
Only about one in ten people respond to a third set of injections if the first two sets fail.
How effective is it?
The goal is not to become completely free of headache or migraine; but to improve quality of life, and to convert migraine from chronic to episodic.
About one in four patients do not respond; one in four responds well to the first or second set of injections, and half need more than two sets of injections to get a good response. Studies show that 47% of patients had a 50% or greater reduction in the number of days with headache.
The biological effect of botulinum toxin on nerves takes several days or a few weeks to work. You should not expect chronic migraine to improve properly in less than 4 weeks. Some patients do not start to improve until after their second set of injections which is given 12 weeks after the first set of injections.