Headaches & BOTOX
Cecile E.F. Becker, MDNeurology
HeadachesTension-type headachesChronic daily headachesSecondary headachesMedication Overuse headachesCluster headachesSinus headachesMigraine headaches
Migraine HeadachesCommon MigraineClassic MigraineChronic MigraineBasilar migraineComplicated migraineOcular migraineAbdominal migraine
Initiation of A MigrainePicture: Craig Blackwell, M.D.
Genetics8% of children, 6% of men and 18% of womenFamily history in 80% of migraine sufferersChromosome 19 for Familial Hemiplegic Migraine
Migraine headachesNausea and/or vomitingPhotophobia and phonophobiaSensitivity to smellAllodyniaThrobbing painUnilateral pain
TriggersCured, smoked or deli meatAged cheesesAvocado, guacamole, bananas, dried fruitChocolateMSGAspartameBeer and wineCaffeine
TreatmentsPreventive medicationAbortive medicationHolistic approachNon prescription medications
Preventive medicationCalcium channel and Beta blockersTricyclic Anti-depressants: Nortriptyline, amitriptylineAnti-epileptic medications: Topiramate, Valproic acid, gabapentinBOTOX injections
Abortive medicationsTriptans: Sumatriptan, rizatriptan, zolmitriptan etcMigranal nasal sprayMidrinFioricetOTCs: Ibuprofen, acetaminophen, Naproxyn, Aspirin
Holistic TreatmentsAccupunctureYogaDiet modificationButterbur, Magnesium, Riboflavin, and Co-enzyme Q10ExerciseBiofeedbackRelaxation therapy
Chronic migrainesChronic Daily Headache for at least 3 monthsMore or equal to 8 days per monthFulfils criteria for migraine without aura and/or treated and relieved by triptans or ergotsThere is no medication overuse or secondary cause
Botulinum Toxin1793- Human outbreak linked to sausages1870- Disease named botulism1895- Organism isolated1944- Toxin isolated1949- Toxin blocks neuromuscular transmission1973- Animal experiments1980- Treatment of strabismus
Botulinum ToxinNeurotoxin Produced by Clostridium botulinum bacteria.There are at least 7 types of botulism toxins: A, B, C, D, E, F, and G.Humans are affected by A, B, E and rarely F.
BotulismFood borne botulism
BotulismFood borne botulismIntestinal botulism
BotulismFood borne botulismIntestinal botulismWound botulism
BotulismFood borne botulismIntestinal botulismWound botulismInhalation botulism
Mechanism of Action
Cosmetic BOTOXPicture: Allergan
Other Available Botulinum ProductsMYOBLOC- Botulinum Toxin BXeomin- Botulinum Toxin ADysport- Botulinum Toxin A
BOTOXFirst approved in 1989 for strabismus and blepharospasm.Approved in 2010 for Chronic migraine HA
Uses for BOTOXStrabismusCervical DystoniaBlepharospasmUpper limb spasticityOveractive BladderExcessive underarm sweating when anti-perspirants failChronic migraines
Botulinum ToxinBlocks release of AcetylcholineBlocks Substance P
Onset of action3-10 daysResults last for 3-6 monthsResults frequently improve with subsequent injectionsHeadache frequency is decreased by 9 headaches per month
Who qualifies for BOTOX injections for migraine Headaches18 years of age or older15 migraines per month or moreLasting at least 4 hrs each timePreventive medications were tried and ineffectiveNo contraindication
The injections31 small injections 155-195 Units of BOTOXTakes 5-10 minutesPerformed in the office
ContraindicationsIf you are allergicNeuromuscular diseases such as Myasthenia Gravis or ALSInfection at the injection site.
Side EffectsEyelid droopingBleedingBruisingHead dropWeaknessInfection
Side EffectsMuscle weaknessDifficulties swallowingDifficulties breathingDouble vision and blurry visionPain at the injection site.