Headaches & Botox

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  • Headaches & BOTOX

    Cecile E.F. Becker, MDNeurology


  • HeadachesTension-type headachesChronic daily headachesSecondary headachesMedication Overuse headachesCluster headachesSinus headachesMigraine headaches

  • Picture: blog.brainhq.com

  • 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 Toxin

  • 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

    Picture: Scientopia

  • Picture: Allergan

  • 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

  • Picture: Allergan

  • 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.