Botulinum Toxin for Migraine

What migraine is

Migraine is the commonest headache disorder and many people have it. It affects daily life heavily, and light, sound and alcohol can all be involved.

Migraine attacks affect social life and working life. There is no permanent cure.

During an attack, take a painkiller and wait for it to pass in a quiet, dark place.

What exactly causes migraine is also not known, which makes it harder to treat. The condition is common, and over time it advances and causes long-standing pain. Migraine varies in severity and can be eased under the care of a neurologist.

What triggers it

The exact cause is not known. The main contributing factors are

• Alcohol
• Various medicines
• Periods and hormonal changes in women
• Being very emotional and sensitive
• Being overweight
• Becoming tolerant to the painkillers used for migraine

What an attack is like

The signs differ from person to person, and attacks usually last 4 to 72 hours. During an attack there is headache and throbbing at specific points. Vomiting and nausea occur in some cases. How severe the pain is, and where it sits, change with the situation.

Patients usually become very sensitive to sound and light, and feel better in a dark place. Heavy physical activity also triggers the pain. Visual problems such as blurred vision appear in some patients as the attack continues.

Botulinum toxin

Not knowing the cause makes migraine hard to treat. Even so, botulinum toxin given by injection is known to help. That effect was discovered by chance.

Botulinum toxin acts on the nerves in the brain that produce pain and stops them releasing their signal. In this way it aims to prevent migraine attacks.

This is a medical treatment, and it must be given by a specialist doctor.

The method is still being studied. It also relieves the trapping of nerves in the head and neck region, which is known to play a part in migraine pain. The aim is to treat the muscles, to make them work properly, and so to remove the conditions that produce pain.

Who is it suitable for?

Botulinum toxin is used to treat migraine attacks that have become chronic and to improve quality of life. Before treatment, a neurologist must see the patient first. Treatment can start, if needed, after a physical examination and tests such as blood tests and an MRI scan.

The treatment is not given to:

• pregnant women
• patients with certain health problems
• mothers who are breastfeeding

Apart from these, it is recommended for migraine patients whose attacks cannot be controlled with medicines.

How is it done?

A substance known to help migraine attacks and trapped nerves is injected with very fine needles into the head, the neck and the forehead. The needles are very fine, and it takes about 15 minutes.

For it to work, 2 or 3 sessions are usually needed. Depending on how severe the migraine is, treatment can go on until the attacks are no longer chronic. The gap between sessions is 3 to 6 months and differs from person to person.

The treatment aims to correct the faulty signalling between muscles and nerves, and in this way to reduce the pain.

Where it is given, how, and on what plan depends on how severe the pain is, on the patient’s health and on the type of migraine. The specialist decides how the treatment is given.

Is botulinum toxin used to treat migraine?

Does botulinum toxin have a place in migraine treatment, and how is it used? Let me explain. In migraine it is used mainly to relax muscles. It can also be used for tension-type headaches. The effect differs from person to person, and it cannot be said to work for everyone with migraine. Still, studies have shown that in most people it reduces how often and how badly the attacks come.

This has been shown scientifically as well. In some people, especially those with tension-type headaches, it helps a great deal. When these people have the usual cosmetic treatment (around the eyes, on the forehead and between the eyebrows), their tension headaches often become much milder, and sometimes disappear.