PEDIATRICS

Botulinum toxin Treatment for Chronic Migraines

Chronic migraines are diagnosed by neurologists and are defined as headaches which have occurred at least fifteen days or more in a month over the preceding three months. Pain usually lasts for at least four hours a day for at least 8 days of the month. Chronic migraines are a serious health problem which affect between 1.3% and 2.4% of the population which can prevent them from participating in daily activities, can impact work and family life.

People who suffer chronic migraines have usually tried almost all recommended medication available to them with no considerable result. These people either make continual use of or have lost their faith in pain-relief medication. They struggle to cope with the negative psychological state of mind created by excruciating pain and face the real risk of their health deteriorating.

Clinical trials called PREEMPT carried out in the US showed that Botulinum toxin, which was used for esthetic purposes, is an effective solution for treating chronic migraines. As a result of this scientific study Botulinum toxin injections were approved to be used to treat chronic migraines in 2010 in the US and the UK, and in 2011 in Turkey.

How does Botulinum toxin treat chronic migraines?

Botulinum toxin blocks the chemical transmitters which trigger the pain which causes chronic migraines. By reducing the oscillation of these chemical transmitters the pathways involving nerve endings under the skin are deactivated and the pain is thus controlled before it reaches the brain.

How is Botulinum toxin treatment for chronic migraines implement?

Botulinum toxin injections to treat chronic migraine patients are implemented in a similar manner around the world. Scientific research called PREEMPT has indicated that this method has been proven to be effective in decreasing the frequency and intensity of pain. Patients are injected with 5 units of Botulinum toxin into 31 locations in their forehead, temples, neck and shoulders.

The procedure takes approximately 5-10 minutes and is implemented in the neurologist’s office. It is advised that you do not bow your head or rest horizontally for up to two hours following the procedure to prevent the Botulinum toxin from spreading. Chronic migraine patients are advised not to take a hot shower on the day of the procedure. It takes between 4 and 10 days for Botulinum toxin treatment to be effective. It has uncommon side effects including swelling, redness and tenderness. Ice compresses during the procedure may prevent swelling and pain. Rarely, a temporary weakness of the upper eyelid or asymmetry in the facial muscles can be observed.

The positive effect of Botulinum toxin for migraine treatment

Botulinum toxin can be injected into all migraine sufferers with the exception of children and women who are pregnant or nursing. Scientific studies have indicated that Botulinum toxin treatment is effective on ¾ of patients suffering from chronic migraines. It is advised that patients who do not experience a decrease in pain frequency and intensity after the first Botulinum toxin treatment session should be given a second chance. If patients do not respond to the third session then it is not advised to pursue this method. Botulinum toxin injections are implemented every three months in the first year. The frequency of treatment in subsequent years is based on the patient.

Our Experience

Botulinum toxin injections have been used to treat chronic migraines at the Headache Center at Acıbadem Maslak Hospital since 2013. To date, we have treated 402 patients suffering from chronic migraines with Botulinum toxin injections. We plan to publish scientific papers on the effects of Botulinum toxin on patients suffering headaches by recording each patient’s experiences. Our first publication entitled “Botulinum Toxin to Treat Migraines” was published in 2013 in a prestigious Turkish journal. Our next publication is currently being written and it covers our cumulative experience in recent years. Our experiences are similar to that of our international counterparts. Patients suffering chronic migraines experience a decrease in affected days and pain intensity within a month following Botulinum toxin injections. This has led to an increase in patients’ quality of life.