But Hang On: Migraine Sufferers Who Dont Find Relief From The Typical Drug Classes May Now Benefit From A New Class Of Therapy
Migraines are surprisingly prevalent. They affect 39 million people in the United States.1
Most migraine sufferers experience attacks once or twice a month, but more than 4 million people have chronic daily migraines. That means they have at least 15 migraine days per month 90 percent of them are unable to work or function normally during those days.1
The good news is that there are several prescription drugs from several different classes that treat acute migraines. Many of those drugs have generics available. Plus, there are new drugs to try and still others in the pipeline. But it can be a real headache for migraine patients to keep trying different drugs, hoping to find one that will give them relief.
What To Expect During Botox Treatment
Before your first Botox treatment your neurologist should discuss the side effects and risks. This is a good time to ask questions and check if they follow the established Botox protocol for chronic migraine.
Your neurologist uses a small needle to inject 0.1ml or 5 units of Botox at each site just under your skin. You may feel a slight sting with each injection. Because Botox comes in 100 unit vials some neurologists may do a few more injections around areas where you experience your migraine pain.
The treatment takes about 1520 minutes and there arent any restrictions on driving or other daily activities after treatment.
Its important to remember Botox isnt a quick fix for migraine. It often takes 2 or 3 treatments to notice if its effective in reducing the frequency or intensity of your migraine pain. Botox treatment is repeated every 12 weeks, which means it may take 69 months to notice any difference. Some people have reported improvements after their first treatment, so like many migraine treatments results are very individualised.
Many people report the benefits of Botox start to wear off after about 10 weeks, and the intensity and frequency of their migraine attacks increase close to their next treatment date.
You dont need to stop taking other preventative medications with Botox treatments and you can continue to use abortive medications if you need them.
Criteria For Considering Studies For This Review
Types of studies
We considered all prospective, randomised and quasirandomised, doubleblind, controlled trials of all serotypes of botulinum toxin. We included all identified trials of this type irrespective of their publication status.
Types of participants
18 years of age and over
suffering from migraine as defined by any edition of the International Headache Society criteria , or meeting reasonable criteria designed to distinguish between migraine and tensiontype headache. People with both chronic and episodic migraine were included in this review.
Types of interventions
Injections of botulinum toxin into head and neck muscles compared with placebo injections, active preventative agent or the same drug treatment with a different dose. We also included trials allowing the use of concomitant preventative or rescue treatment.
We made a note of whether rescue medications for acute migraine or concomitant medications for the prevention of migraine were permitted.
Types of outcome measures
Number of migraine days per month .
total number of participants experiencing any type of adverse event
total number of participants experiencing the specific adverse event types blepharoptosis, muscle weakness, neck pain and injection site pain
total number of participants experiencing a treatmentrelated adverse event, as determined by trial investigators
withdrawals due to adverse events.
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Ongoing Evidence To Support Botox
Further prospective and retrospective studies support the results of the PREEMPT study. The COMPEL study, which began in 2011, included 716 patients with an average of 22 headache days per month. The participants received 155 units of Botox at the 31 injection sites from the established migraine protocol every 12 weeks for 2 years. Just over half the participants completed the study and by weeks 60 and 108, there was a significant reduction in headache days reported.
In 2019, researchers reviewed the data from 211 patients who received Botox at 7 private neurology practices in Australia. The study found 74% of patients benefitted from Botox treatments, including reduced headache days and a decrease in the number of days they used acute pain medication.
How Does Botox Help With Chronic Migraines
The active ingredient in Botox is botulinum toxin type A, a neurotoxin typically used cosmetically to reduce the appearance of facial lines.
While Botox is usually employed to treat wrinkles, it can also help patients who regularly get headaches. In 2010, Botox was granted FDA approval for use in the treatment of chronic migraines.
Botox is considered a preventative treatment. Its believed Botox alleviates migraines by preventing the release of chemicals that transmit pain signals. The exact mechanism is still not fully understood.
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Where Are Forehead Lines
Forehead wrinkles stretch horizontally across your forehead above your eyes and eyebrows. The forehead is typically the first place that you begin to see wrinkles as you age. Considering that we utilize the muscles in our forehead for pretty much every facial expression in the book, it really isnt much of a surprise that forehead wrinkles pop up first. Whether youre smiling, frowning, furrowing your brow in frustration, or scrunching up your face while deep in thought, the forehead is the area primarily affected.
Advantages Of Botox For Migraines
With most patients, we look for an improvement of more than 50% in the frequency and intensity of chronic migraines. For instance, if you experience 21 days of migraines per month, your 50% reduction in frequency would bring your total migraine days down to 10-11 days a month.
In most trials and studies, nearly 50% of patients achieved this goal after six months of treatment .
Some clients respond extremely well to the treatment. These types of patients are classified as super responders. They result in an approximately 75% reduction in migraine frequency.
A decrease in migraine frequency is not the only benefit observed after a Botox treatment. The other complimentary benefits of the therapy include:
- The migraine attacks are less severe than before.
- The episodes are much easier to control and respond better to rescue remedies.
- The baseline neck pain and headaches are less intense.
- The tolerance to migraine triggers are much higher than usual.
- The person functionality is improved and helps to retain normalcy in day-to-day life.
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Its Not Just For Celebrities
Judging from the flat foreheads of most Hollywood A-listers, Botox is a given among celebrities. While weighing the decision whether to get it myself, I tried casually bringing it up in conversation in my own social circle.
In doing so, I was surprised to learn how many of my friends and acquaintances had already had it. Apparently its really not that uncommon.
At around $10 to $15 per unit, you can expect to pay between $200 and $300 for the 8 to 20 units of an average forehead treatment. I paid $260 for the injections to my forehead and between my brows. Expensive, yes, but not Oscars-red-carpet expensive.
A Closer Look At Real
FDA-approved dosing for Botox is 155 units per treatment. However, vials sizes come in 100 units and 200 units. That causes waste of 45 units per treatment, for which providers are allowed to bill.
Botox treatment for chronic migraines is quarterly. Each treatment involves 31 separate injections of 5 units each in seven areas around the face and neck. It can take up to six months to see the maximum benefit from Botox.2 Primes study showed 18 percent of members do not receive the second treatment another 18 percent drop before the third treatment. Only 47 percent of members in the study stayed adherent for the full year of the study.
The Botox treatment was not associated with a decline in migraine-related medical and pharmacy costs. Annual average migraine-related costs for the member before starting Botox migraine therapy was $2,467. In the year after starting Botox, the annual average migraine-related cost was $7,422.
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How Many Units Of Botox Is Normal
If youre considering rejuvenating cosmetic treatments like Botox or dermal fillers for the first time, youve probably already started your google research, taking a look at various beauty treatments to give you that youthful, revitalized look youve been dreaming of. You may now be wondering how much is enough? or how much is too much? essential questions when considering something like Botox treatment. Though every treatment is dependent upon the desires of the patient, collaboration with an expert cosmetic dermatologist, like Dr. Michele Green, is the key to having the best Botox results. During the consultation with Dr. Green, you will discuss with her the various areas of concern and injection sites, and there are some standard points of reference when it comes to the units of Botox needed per area.
Botox has many cosmetic and medical uses. It is a protein derived from a neurotoxin known as botulinum toxin that the bacterium Clostridium botulinum produces. Botox, along with similar cosmetic procedures and Botox alternatives such as Dysport and Xeomin, Revance, and Jeauveau, is an injectable treatment that can help treat fine lines and smooth out wrinkles on different areas of the face. The most popular areas for Botox on the face are the glabella, forehead, crows feet , and neck. In addition, Dr. Green injects many patients for Botox for the masseter area, for facial slimming, and for the axillae for hyperhidrosis.
You’ll Have To Get Dozens Of Shots
Though migraine symptoms vary from person to person, Botox for migraine is standardized. Every three months you’ll receive 31 shots totaling up to 155 units of Botox. This includes injections in specific spots in the forehead, temples, back of the head, neck, upper back, and shoulders.
If you’ve got a particular concern, like muscle spasticity or tightness in the shoulders, your provider may adjust the shot pattern to tackle that specific issue.
If Botox is working for you, there’s no known health risk associated with staying on it indefinitely, though it’s not approved for people who are pregnant or breastfeeding because of minimal studies in these groups.
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What Type Of Headache Responds Best To Botox
Botox is only FDA-approved for chronic migraines, which means headache on 15 or more days a month. The more frequent the headaches, the better the patient does with Botox, says Dr. Andrew Blumenfeld, Director, The Headache Center of Southern California. Botox is not recommended for patients who experience fewer than 15 headache days a month.
What Are Botox Treatments Like
Unlike other migraine treatments, Botox is given as a series of small injections directly into the muscle.
In a single treatment session, between 31 and 39 shots are given throughout seven different parts of the forehead, head , and neck . Each treatment cycle can last about 10 to 20 minutes. Its important that the correct sites are treated, or else the treatment may not be as effective.
Its recommended that a treatment cycle be given every 3 months in order to help control migraine attacks. How long you continue getting them will depend on how you respond to treatment. While many people improve with just one treatment cycle, some may require more. Most people seem to need fewer than three treatment cycles, but each person is different. Your doctor will work with you to see how long you should continue getting treatments and may recommend that you keep taking other medications until you see an improvement.
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How Does It Work And How Effective Is It
Though there’s still more research to be done on Botox for migraines and doctors aren’t yet completely sure why the procedure is effective, they have some ideas. Ravitz tells me, “What does is paralyze nerve terminals. Essentially, nerve terminals transmit pain, but they also produce pain substances while theyâre doing that, and it completely paralyzes that process.” She says that it stops the process of pain patterning and it also relaxes the muscles.
According to Ravitz, it’s very effective among a large sampling of her patients and is usually very well tolerated. She says some of her patients find that it even eliminates the need for medication, which is a huge deal. However, she also says, “About 7 to 10 percent of my patients find that itâs not effective and they actually feel worse during that time.” As with any medical procedure, everybody is different and will respond to treatment differently, and it’s best to do a healthy amount of research and thoroughly talk to your doctor about your body and medical history before making a decision.
How Much Does Botox Cost
The official dose of BOTOX® used for the Chronic migraine varies between 155 and 195 units. The current cost of a BOTOX® vial of 200 unites is $714 plus pharmacy mark-up and dispensing fee.
Most private plans and some public plans will cover all or part of the cost of BOTOX®. Often times the prescribing physician will have to fill a form to confirm that other preventive medications have been tried without success.
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How Well Botox Works
These studies looked at adults with chronic migraine. The participants received injections of Botox or a placebo . They received injections in two sets, which were given 3 months apart.
Researchers compared the number of headache days that people had at the start of the study with how many they had after 6 months of treatment. The results showed that people who received Botox averaged fewer headache days than people who received a placebo.
There Are Certain Things You Cant Do Afterward
I wasnt planning to run a marathon on the Thursday afternoon after my dermatologist appointment, but I do wish Id known that certain activities are not recommended immediately after Botox.
My doctor instructed that, for the next six hours, I was not to exercise, lie down, or take Ibuprofen , which could increase bruising at the injection sites.
Dr. Williams confirms these guidelines, and adds, Immediately after your Botox injections, keep your head level and do not bend your head forward for two hours. No heavy exercise until the next day.
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Is There A Needle Size And Saline Dilution That You Find Most Useful
The ideal needle to use is a 30G or 31G, half-inch needle. Longer needles are problematic as they encourage deeper injections, which can increase the risk of muscle weakness, and most of the side effects such as neck pain stem from muscle weakness. Perseverative-free normal saline is the only diluent that should be used. There is a case study of a patient who died when onabotulinumtoxinA was mixed with a local anesthetic agent. The pivotal trial established an effective dose using 2 mL/100 units of onabotulinumtoxinA. A fact that is often overlooked is that the mean dose in the trial was 165 units. The patients all received 155 units with a fixed dose, fixed-site injection protocol, and an option of an additional 40 units to follow the pain. This resulted in a mean dose of 165 units, which is the standard that should be used to achieve the efficacy results reviewed above.
Recent Studies On Bonta Efficacy
There has been much debate on the efficacy of BoNTA in treating headaches.7 This is secondary to inconsistencies found in previous smaller studies. More recent trials, however, started to prove the effectiveness of BoNTA in migraine prevention. 2,7-9 The largest trials were conducted by the pharmaceutical company Allergan, makers of Botox.8,9 The PREEMPT study examined the efficacy and safety of using Botox for chronic migraine prophylaxis in a total of 1,384 patients.8 Each study was randomized, double-blinded, and placebo-controlled in nature.
Additionally, each study consisted of a 24-week double-blind phase with two injection cycles, followed by a 32-week open-label phase with three injection cycles. Botox or placebo was administered in fixed doses at 31 specific sites across head/neck muscle areas. The maximum dose a patient could receive was 195 units of BoNT. Doses injected in temporalis, occipitalis, and trapezius muscles could vary based on a patient’s symptomatology.
Results were tracked using a telephone diary so patients could record their headache symptoms. At 24 weeks, a statistically significant change from baseline was recorded in frequency of headache days and episode intensity among the Botox group. Other variables included cumulative headache hours and acute medication use. As a result, both studies supported the benefits of Botox treatment by showing a significant decrease from baseline in the frequency of headache days.8
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Is The Use Of Botox Limited To Treating Aging Face
Apart from the Botox benefits on the patients face, the biological blocking powers of this treatment are helpful in treating muscular disorders, migraines, and some bowel disorders. Like Dysport injection, a non-surgical form of wrinkle treatment, Botox can treat muscle stiffness, muscle spasms , overactive bladder, or loss of bladder control, too. It also helps in stopping excessive sweating.
Which Other Areas Of The Face Can Botox Treat
Aside from the forehead, the common facial area thats treated with Botox are areas with dynamic wrinkles like crow’s feet and the frown lines, which become more pronounced when you make a facial expression. No matter which Botox provider you decide to visit, it will always be measured out in units.
Allergan, the manufacturer of Botox Cosmetic, suggests that the following units should be given:
You can get multiple injections during your visit. So if you were looking to get all three areas done, you would need 64 units. This may be less depending on the severity of the area of treatment. Remember that this is simply a guide. Your cosmetic professional is the best person to make recommendations. Be sure you always listen to their suggestions and let them know if you have questions or concerns.
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