BOTOX Treatment for Migraine

BOTOX®
Headache Care Center physicians have been treating clinic patients with BOTOX® injections for over 10 years and have performed multiple research studies to determine the most effective use of BOTOX® to treat migraine. As a result, we have honed in on the most effective locations for injections and what type of patients tend to respond the best. Between clinical experience and research, our physicians are very experienced in performing this technique.

The PREEMPT Study was conducted by our research division, Clinvest, along with other sites throughout the country. This study was the basis for the Federal Food and Drug Administration (FDA) giving approval for the use of BOTOX® in the treatment of chronic migraine. Chronic migraine is defined as 15 or more headache days per month, each headache lasting 4 hours or more, with 50% of the headaches being migraine or probable migraine. Because of his extensive work in this area, Dr. Cady was selected as a National Trainer for physicians who wish to learn this technique in accordance with FDA guidelines.

What is it?
BOTOX® is a prescription medicine that is injected into muscles to prevent headaches in adults with chronic migraine. Chronic migraine is defined as 15 or more headache days a month with headache lasting 4 or more hours each day.
BOTOX® is the brand name for onabotulinum toxin type A. It is produced by Allergan Pharmaceuticals for medical and cosmetic use. There are multiple conditions for which BOTOX® has been approved for treatment by the FDA. However, at Headache Care Center, our focus is strictly on the treatment of chronic migraine.
Other botulinum toxins available on the market include Myobloc®, Dysport®, and Xeomin®. Because of our extensive use and study, at Headache Care Center we prefer to use BOTOX®. It is important to tell your physician if you have been treated with any botulinum toxin prior to injections. Each form is slightly different from the others, and the dosages are not the same for each form of botulinum toxin. Therefore, using two different forms of botulinum toxin at or close to the same time can result in negative side effects.

How does it work?
BOTOX® blocks chemical changes on nerve endings. To treat chronic migraine, BOTOX® is injected into muscles of the forehead, the side and back of the head, and the neck and shoulders to produce a partial and temporary chemical “denervation” of the muscle. This causes the muscles to be too weak to contract. The dosage used to treat chronic migraine is very low since the muscles injected are small.

Effects?
BOTOX® is not a cure for migraine. It is just one of many treatment options. Treating chronic migraine with BOTOX® injections is safe and can be very effective. It may take up to 2 weeks for the BOTOX® to take effect, but that effect will last approximately 3 months. BOTOX® may not prevent or eliminate all headache pain, but our patients report the need for medication is significantly less.

Side Effects?
In our experience, the most common side effects associated with BOTOX® injections include bruising and slight discomfort at the injections sites, drooping eyelid, headache, and muscle pain and stiffness. These symptoms usually occur within the first two weeks following injection and are usually mild and very temporary. Because some of the injections are given into the forehead, many report they cannot raise their eyebrows for the 3 months the BOTOX® is in effect. This is a concern for some, and it should be considered if limiting your facial expressions will be an issue for you. More serious side effects typically occur with treatment of other disorders in which a much higher dose of BOTOX® is used.
We strongly recommend the injections be performed by a physician trained in this procedure and experienced in treating migraine.

Pros?
BOTOX® can be very effective in controlling chronic migraine, and it is safe when given by a physician trained in the proper technique. Another benefit is you do not have to remember to take your preventive medication daily, so compliance is not an issue. If a migraine does occur, our patients report their acute medication is often more effective than before the injections.

Cons?
The inability to raise the eyebrows is an issue for some people. When treating for chronic migraine, the muscles of the forehead are injected. This side effect should be considered before the injections are done if not being able to make facial expressions would be a negative side effect for you.

The cost can be a negative factor. Treatment with BOTOX® is expensive, and although the treatment of chronic migraine is now an FDA approved indication, many insurance companies do not cover the cost. At Headache Care Center we attempt to determine your out-of-pocket cost prior to receiving the injections. However, there is no guarantee insurance will pay for the service or the BOTOX®, even if it is a covered benefit. Ultimately, it is the responsibility of the patient to pay for the procedure if insurance does not cover it. This should be considered before the procedure is scheduled. However, in making your decision to receive BOTOX® injections, consider your current monthly migraine treatment costs. Over three months, your spending may be equal to or exceed the cost of BOTOX® injections.

Hypersensitivity Reactions:

Serious and/or immediate hypersensitivity reactions have been reported. These reactions include anaphylaxis, serum sickness, hives, soft tissue edema, and trouble breathing.

Who should not use BOTOX®?
You should not receive treatment with any botulinum toxin if you have any of the following:

Presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation.
If you take aminoglycosides or other agents that interfere with neuromuscular transmissions.
If you take anticholinergic drugs.
If you have Pre-existing Neuromuscular Disorders: peripheral motor neuropathic diseases, amyotrophic lateral sclerosis (ALS), or neuromuscular junctional disorders (myasthenia gravis or Lambert-Eaton Syndrome). These patients may be at risk of clinically significant effects including severe difficulty speaking and/or swallowing and respiratory problems from typical doses of Botox.
If you have received other forms of botulinum toxins at the same time or within several months of each other. The effect is not known, but it is believed use of multiple forms of botulinum toxin at the same time could create excessive muscle weakness. Be sure to tell your doctor if you have used BOTOX®, Myobloc®, Dysport®, or Xeomin® in the past.
The use of a muscle relaxant just before or after injections. This may cause excessive weakness.
Pregnancy: BOTOX® is a category C drug. There have been no well-controlled studies done with pregnant women. Headache Care Center does not inject BOTOX® in women who are pregnant.
Nursing mothers: It is not known whether BOTOX® is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when BOTOX® is administered to a nursing woman. Headache Care Center does not inject BOTOX® in women who are nursing.
Pediatric use: Safety and effectiveness in patients below the age of 18 years has not been established.
Episodic migraine: Safety and effectiveness have not been established for the prevention of episodic migraine (14 headache days or fewer per month).

Testimonials

Sandra, Missouri:

“Very simply, Botox has given me most of my life back. I had daily migraine headaches when I sought out the Headache Care Center. I was so very tired of trying medications that didn’t work or had horrible side effects. Dr. Cady and Dr. Dexter tried Botox quickly at the onset of their treatment strategy for me and I had amazing results. It took a couple of weeks to feel the full effects, but I have had at least two thirds of each month nearly or completely headache free. I feel confident that I can eventually become completely headache free with this treatment. I would recommend it to anyone suffering as I did.”

Sheila, Missouri:

“Botox has been a part of my migraine preventive care for several years now. To refer to Botox as a ‘cure’ for migraines in my opinion would be an inaccurate claim. However, I have gone from a dozen or more migraines a month to only two migraines in the last 6 months; both of which were ended quickly by my rescue medication. Botox is a vital factor in managing my headaches. I’m so very thankful for everyone at Headache Care Center!”

Pam, Missouri:

“I have experienced migraines since I was a child and have tried everything on the market from Imitrex to acupuncture. I’ve had various cycles with my migraines throughout my life, but I was at an all-time high of headaches during a month when I found Botox. My doctor saved my life when he split my headaches in half with the first set of injections. I now have more valuable time to spend with my husband, children and grandchildren. I can schedule trips easier, and my daily life is getting so close to normal that I feel so blessed to have found this treatment.”

How can you get BOTOX® injections for chronic migraine?

Call Headache Care Center at 417-890-7888 or toll free 866-899-0745
If you prefer, email your contact information and our Nurse Manager will contact you.

Source:

BOTOX® package insert, Allergan, Inc. Revised October, 2010.
Allergan, Inc. announcement document regarding FDA approval of the use of BOTOX® for the treatment of chronic migraine, October, 2010.