I received many comments in my previous video about migraine.
Some people were surprised to hear about botulinum toxin for migraine.
So, today I will answer 10 questions: 1- How does botulinum toxin help migraine?
2- What type of migraine does it help?
3- Where are the injections applied?
4- How much does it cost for one session?
5- How long does the effect last?
6- Who gives these injections?
7- Are there any contraindications?
8- Does it hurt?
9- Are there any side effects?
10- Will it change my face?
So, let’ talk about Botulinum Toxin for migraine today.
Before I continue, let me remind you that this video is not intended to provide medical
advice.
If you have a condition that causes pain, please talk to your doctor.
This video is only for educational purposes.
If there is an emergency, call an ambulance or go to the nearest emergency department.
Onabotulinum toxin A has many brand names.
In Canada there are three products available, the trade names are Botox®, Xeomin and Dysport.
This video is NOT sponsored by any of these brands.
The discovery that Botulinum Toxin was helpful for migraine was by accident.
Some people were receiving injections around the face for wrinkles, and they noticed that
their migraine attacks were less frequent or less intense.
Then, researchers started doing clinical trials and discovered that it actually reduced the
number of migraine attacks, and that is why it is now an established treatment for chronic
migraines.
A migraine is not just a severe headache.
I have another video in that I explain the difference between migraine and headaches.
This is important because Botulinum Toxin should not be used in people with other types
of headaches, like tension-type headaches or trigeminal neuralgia.
In some cases of cervicogenic headache, Botulinum Toxin can be used in the neck muscles, but
I personally don’t think that is a good idea, because when the cause of headache is
myofascial trigger points, the muscles need to be strengthened, not weakened or paralyzed,
as what happens with Botulinum Toxin injections. 1- How does Botulinum Toxin help migraine?
Migraine is a type of headache where the sensory nerves are sensitized.
It is a type of primary chronic pain.
Botulinum Toxin blocks the substances that sensitize the sensory nerves and reduce the
electrical activity of the pain network on the face, head and neck.
We also have muscles in the face, on the side and back of the head.
The Botulinum Toxin will relax these muscles too.
2- What type of migraine does Botulinum Toxin help?
In Canada, Botulinum toxin is approved for chronic migraines.
Chronic migraines are when the person has more than 15 days of headaches a month for
at least three months.
Watch my other video about migraines to learn more.
3- Where are the injections given?
The whole session involves between 30 and 40 small injections distributed in the area
above the eyes, the forehead, the temples, the top and the back of the head.
Sometimes the doctor will also inject the muscles of the neck.
The protocol varies, but it includes between 155 and 195 units of Botulinum Toxin in total.
4- How much does it cost for one treatment?
In Canada, one vial of the brand Botox with 200 units costs around $800 dollars, plus
the pharmacy mark-up and dispensing fees.
In some Canadian provinces, the government covers this cost if the patient meets specific
criteria for chronic migraines.
The physician fees are usually covered by the public health system.
In other places, the physician may charge a fee for administering the injections.
5- How long does the effect last?
The effects start approximately one week after the injection, and they last 3 months.
The injections need to be repeated every 3 months.
There are no known risks of repeating these injections if the person continues with an
improved quality of life.
Not everyone with chronic migraine benefits from Botulinum Toxin injections.
The studies show that about 50% of people will have some benefit, and these benefits
include a reduction in the intensity of pain, fewer days with migraine, better response
to medications to abort a migraine attack, and less gastrointestinal symptoms like nausea
and vomiting.
It is important to keep a headache diary to document the symptoms for at least 30 days
before and 30 days after the injections.
This diary will show if the Botulinum Toxin has been beneficial or not.
6- Who gives these injections?
In Canada, Botulinum Toxin for migraines is injected by medical doctors who have been
trained in the migraine protocol.
They can be physiatrists like me, neurologists, family doctors, anesthesiologists, or surgeons.
If the botulinum toxin is injected into the wrong muscles, it could be harmful and paralyze
the muscles.
If the toxin is not properly stored and prepared it loses its effects.
7- Are there any contraindications?
There are some contraindications to Botulinum Toxin injections:
- Pregnant women - People who have neuromuscular diseases
- People who are known to have an allergy to botulinum toxin
8- Does it hurt?
The needles are very small, but the person with migraine may have more sensitization
of the skin, which we call allodynia.
If they have hypersensitivity, the injections might be more painful.
They can practice some relaxation techniques to feel less pain during the procedure.
We don’t recommend them to use any topical anesthetic or take painkillers as the procedure
is very quick.
It takes approximately 15 minutes.
If you have fear of needles, or fear of pain caused by needles, watch my other video where
I show some techniques to overcome fear of needles.
9- Are there any side effects?
Side effects are very rare when Botulinum Toxin is injected into the migraine points.
If the doctor injects in the wrong spots, like in the neck, they may paralyze the muscles
that control swallowing, or cause weakness in the neck.
10- Will Botulinum Toxin for migraine change my face?
In some cases, there might be difficulty to open the eyes because the toxin will weaken
the muscles that open the eyelids.
There might also be changes in the forehead wrinkles and a decrease in frowning.
But these effects are reversible after 3 months.
If you like this video don’t forget to give your thumbs up.
Leave your comments below and share it with your friends using this button here.
Goodbye