Why Should I See Dr Enayati Or Dr Gruver For Headache Solutions
Dr. Enayati and Dr. Gruver are pain specialists with extensive experience in treatment chronic migraines with Botox. He likes this approach, because it does not have the same side effects that come with taking pills every day and decreases the likelihood of breakthrough headaches requiring additional medication. It is also a more targeted treatment. You should see a top headache and migraine specialist who can diagnose the precise subtype of headaches that you are experiencing, in order to guide you towards the most effective treatment option!
Working Of Botox For Migraines:
Botox injections for migraines cause an inhibition of the pain caused due to a chronic migraine through the reduction of the pain pathways where the nerve cells in the trigeminovascular system are involved. The trigeminovascular system includes a sensory pathway that plays a vital role during a headache arising out of a migraine attack.Click the images below to place your order
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The Botox treatment for migraines last for a period of 10-12 weeks and according to the experience of patients, 2 treatments are known to reduce a headache by half.
How Do I Access Botox
Botox is only available on the NHS for people with chronic migraine who have tried at least three other preventive treatments. It is currently only available via a specialist such as a headache specialist or consultant neurologist.
If you think you are eligible for Botox and would like to considered for treatment you can ask for a referral to a specialist. The specialist will assess your history and symptoms to make sure Botox is an appropriate treatment option for you. You should be asked to keep a headache diary to monitor the effectiveness of the treatment.
If Botox doesnt work for you or stops working your specialist will discuss other treatment options with you.
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The Path To Migraine Use
Botox was first used in the 1970s by ophthalmologists to treat eye conditions such as blepharospasm , and squint. Since then, its been approved to treat other medical conditions including bladder dysfunction, muscle contractions and excessive armpit sweating.
In 1998, an American plastic surgeon reported some of his patients receiving cosmetic Botox experienced an improvement in their migraine headaches after treatment.
Encouraged by other anecdotal evidence, researchers began to formally study the efficacy, safety and tolerability of Botox for chronic migraine through clinical trials. The most notable trials were the Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy clinical program, or PREEMPT study.
The PREEMPT study involved 2 double-blind, randomised, placebo-controlled clinical trials involving 1,384 people who fulfilled the trial criteria of chronic migraine. Half the participants received Botox injections and the other half received a placebo.
The results from the clinical trials were combined and the study concluded treating chronic migraine with Botox reduced the number of migraine days and reduced headache-related disability.
From PREEMPT, the Food and Drug Administration approved Botox for use in chronic migraine in 2010. In Australia, Botox was approved for use in chronic migraine in 2011.
Botox is the brand name of onabotulinumtoxinA approved for chronic migraine and is made by the pharmaceutical company Allergan.
What Are The Risks Of Using Injectables For Migraines
Botulinum toxin injectables should be avoided by pregnant women and nursing mothers, as well as people with an allergy to proteins in cows milk.
When given by an experienced and qualified health care specialist, botulinum toxin injections are relatively safe. However, some people experience pain, bruising or swelling where the drug was injected. Other possible side effects are:
- Headache or flulike symptoms
- Drooping on one eyelid, eyebrow or side of the mouth
- Drooling
Very rarely, if the toxin accidentally spreads into your body, other, more serious symptoms might occur over the course of hours or days. :
- Vision problems
- Inability to control the bladder
- Difficulty breathing
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How Often Do I See My Doctor For Botox Injections For Migraine
You will usually start with 2 treatments spaced 12 weeks apart. Once you and your doctor see how you respond to Botox for migraine, you will then continue treatments every 12 weeks if it is working well for you.
The recommended retreatment schedule of Botox for migraine prevention is every 12 weeks. This means you will only need to receive injections 4 times per year or as directed by your healthcare provider.
What Happens Before Botox For Migraine Treatment
Starting a new course of Botox® for migraine treatment is a major step. So, before recommending treatment your Consultant will have checked that its a suitable treatment for you. As a guide, you shouldnt have Botox for migraine treatment if:
- Youve had a bad reaction to botulinum toxin type A treatment in the past
- You have an infection at or around any of the areas to be injected
- Youre pregnant or breastfeeding
Before you start your Botox® for headaches treatment, your Consultant will discuss what the treatment involves and what you can expect, including any side effects. Once your treatment has started, if you notice any side effects then you should tell your doctor straight away.
You should continue with your migraine diary, noting down:
- How many times you get headaches or migraines each month
- How long they last
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How Quick Does Botox Work For Migraine Headaches
In studies, some patients felt headache results as soon as 4 weeks. If Botox for migraine prevention works for you, you should usually see results after the second set of injections at 12 weeks.
In 6-month long studies, patients continued to see reductions in their number of headache days on most days over the study period. Botox also lowered the total length of time of headaches on days when they occurred over the study period, when compared to placebo .
What Are The Criteria For My Insurance To Cover Botox
Different insurance companies have different criteria, but these are frequently seen:
Different insurance companies have different criteria, but these are frequently seen:
- A diagnosis of Chronic Migraine
- Previous trial and failure or side effects with 1 or more migraine preventive medications
Different insurance companies have different criteria, but these are frequently seen:
- A diagnosis of Chronic Migraine
- Previous trial and failure or side effects with 1 or more migraine preventive medications
Some companies will require a proof of effectiveness, like a 30% or 50% response in frequency, improvement in some quality of life scales .
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Side Effects And Risks
Like other medications, there are a few side effects and risks with Botox, though most are rare and only temporary.
The most common side effect following Botox treatment is neck pain, reported in about 9% of people during the PREEMPT study.
About 5% of people from the PREEMPT clinical trials reported a migraine following treatment, however headache and migraine usually occur within the first month of treatment and decrease with repeat treatments.8
Other side effects include:
- pain at the injection site
- muscle pain and weakness
- itching
- upper respiratory tract infection.
Rare but serious side effects include breathing and swallowing problems and the spread of the Botox toxin.
Botox for chronic migraine is only approved for people aged 18 and older and its safety during pregnancy and breastfeeding is unknown.
Botox For Chronic Migraines
Migraines can cause nausea, sensitivity to light and significant pain for hours to days, keeping you from performing daily tasks and participating in activities you enjoy. For those who experience chronic migraines at least eight times a month, Botox injections can block pain-causing chemicals in the nerves and bring relief.
Baptist Health is nationally recognized for excellence in treating various types of headaches, including chronic migraines. We offer a full spectrum of neurological care and the latest approaches to pain relief and migraine management, including Botox therapy. Best of all, youll appreciate locations near you and a personalized focus to meet your needs before, during and after your procedure.
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Will I Experience Pain Or Tightness After Botox Injections For Migraine
Your doctor or nurse will ask you to stay at the clinic for a short while, to check that you are comfortable following your treatment.
As with all procedures, you may experience some common side effects. Very rarely there is some pain around where the injection was given. The majority of patients do not experience pain or tightness.
Mayo Clinic Q And A: Botox A Treatment For Chronic Migraines But Not A Cure
DEAR MAYO CLINIC: Is it safe to use Botox injections to treat chronic headache? How does it work, and would I need to have regular treatments? Do patients who use Botox as treatment need to be on other headache medication, too?
ANSWER: Onabotulinum toxin A, or Botox, is approved by the U.S. Food and Drug Administration as a treatment for chronic migraine headaches. It is not a cure. People who receive Botox for headaches usually get the treatment about every three months. For some, that is all they need to keep their headaches under control. For others, additional medication or other headache treatment is necessary.
Botox is a medication that uses a form of botulinum toxin to paralyze muscle activity temporarily. Best known for its ability to reduce the appearance of facial wrinkles, Botox also has been shown to help prevent chronic migraine headaches in some people. Its used mainly for those who have headaches more than 15 days a month.
Since 2002, doctors at Mayo Clinic have treated thousands of patients with chronic migraine effectively and safely using Botox. The medication typically is injected into muscles of the forehead, scalp, neck and shoulders.
The specific details of how Botox works to prevent headaches are not known. But, its likely that the injected Botox is taken up by pain receptors in the muscles nerves. The medication then deactivates those pain receptors and blocks pain signals that the nerves send to the brain.
Read Also: Why Do Migraines Cause Nausea
Is The Effectiveness Of Botox Sustained Over Time
Yes. For most people who respond to Botox, the benefit are sustained over time. Remember that migraine is a fluctuating disease and that even if Botox is effective for you, you may have better phases and more difficult ones.
If you want to read about Botox risks and side effectsgo HERE.
If you want to learn about Botox access and coverage in Canada go HERE.
If you want to prepare for a first injection and see how Botox is injected go HERE.
REFERENCES
- Frampton JE, Silberstein S. OnabotulinumtoxinA: A Review in the Prevention of Chronic Migraine. Drugs. 2018 78:589-600.
- Ashkenazi A, Blumenfeld A. OnabotulinumtoxinA for the treatment of headache. Headache. 2013 53 Suppl 2:54-61.
- Dodick DW, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010 50:921-36.
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What To Expect During Botox Treatment
Before your first Botox treatment your neurologist should discuss the side effects and risks. This is a good time to ask questions and check if they follow the established Botox protocol for chronic migraine.
Your neurologist uses a small needle to inject 0.1ml or 5 units of Botox at each site just under your skin. You may feel a slight sting with each injection. Because Botox comes in 100 unit vials some neurologists may do a few more injections around areas where you experience your migraine pain.
The treatment takes about 1520 minutes and there arent any restrictions on driving or other daily activities after treatment.
Its important to remember Botox isnt a quick fix for migraine. It often takes 2 or 3 treatments to notice if its effective in reducing the frequency or intensity of your migraine pain. Botox treatment is repeated every 12 weeks, which means it may take 69 months to notice any difference. Some people have reported improvements after their first treatment, so like many migraine treatments results are very individualised.
Many people report the benefits of Botox start to wear off after about 10 weeks, and the intensity and frequency of their migraine attacks increase close to their next treatment date.
You dont need to stop taking other preventative medications with Botox treatments and you can continue to use abortive medications if you need them.
What Happens After Botox For Migraine Treatment
Your Consultant or nurse may ask you to stay at the clinic for a short while, to check that youre comfortable following your treatment and to arrange your next appointment, if needed.
You may get some bumps on the skin at the places where you were injected, but these should disappear within a few hours. Try not to rub the places where you have been injected for 24 hours after you receive your injections, to allow your treatment to work properly.
Boxed Warning: Spread Of Toxin Effects
This drug has a boxed warning . This is the most serious warning from the Food and Drug Administration . A boxed warning alerts doctors and patients about drug effects that may be dangerous.
After Botox is injected, the drug may sometimes spread to other parts of the body. This can lead to a serious condition called botulism, which may cause symptoms such as:
- muscle weakness
- difficulty breathing
- loss of bladder control
Its possible for botulism to occur hours, days, or weeks after receiving Botox. If you experience any of the symptoms above after having a Botox injection, you should talk with your doctor.
Rarely, the difficulty swallowing or breathing that botulism can cause can be life threatening. If you already have trouble swallowing or breathing, you may have an increased risk for these problems. Call your doctor immediately if you have trouble swallowing or breathing after receiving a Botox injection. If you think your symptoms are life threatening, call 911 or your local emergency number.
What Can I Expect During Botox Treatment
Botox treatments typically take 20 to 30 minutes. Your physician will use a very small needle to inject tiny amounts of Botox into shallow muscles in your head and neck. People describe the injections as feeling like pinpricks.
You may need between 30 and 40 shots, and youll receive them on each side of the head and neck. If you feel migraine pain often in one specific spot, your physician may administer additional injections at that site.
Botox injections will be administered right in the physicians office and you can go home the same day. Botox for chronic migraines is usually administered every 90 days and patients are often able to decrease or stop taking their other migraine medications.
How Is Botox For Migraines Different From Cosmetic Botox
The Botox used for migraines and the Botox used for cosmetic procedures is actually exactly the same. “Basically, young and middle-aged women were getting for cosmetic purposes, and thatâs the most common person that has migraines, and thatâs how they figured out it was helpful,” Ravitz tells me. Women were getting Botox for aesthetic reasons and happened to notice relief from their migraine symptoms, and doctors began looking into it as a direct treatment. In fact, women are disproportionately affected by migraines â about 85 percent of chronic-migraine sufferers are women, and the condition affects 28 million in just the U.S.
The only difference between the two procedures is that with Botox for migraines, they may do a few more shots in areas where the pain is experienced. Personally, I usually get between 30 and 40 shots, concentrated mostly on the right side of my head where the pain occurs, at the base of my skull, and on my neck and shoulders, where I tend to hold tension, as doing so can cause a migraine. Botox for migraines can have the same aesthetic effect that cosmetic Botox has, which kills two birds with one stone for people who may desire that effect. “We do it along wrinkle lines and keep it symmetrical,” says Ravitz, which explains the erasing of lines and temporary plumping of wrinkles.
What Is A Migraine
Migraine is a common condition that causes debilitating headaches. Unlike regular headaches, migraines are intense and can cause symptoms including nausea, vomiting, light and sound sensitivity, numbness, tingling, and trouble speaking.
People can experience migraines at any age. Some individuals experience migraines during childhood, but it may also begin in the early adult years. Genetics are a prevalent cause of migraines, given that they frequently run in families.
Adding Botox To Your Treatment List
Botox has been used to treat medical conditions for many decades and its an evidence-based treatment option for people with chronic migraine. Side effects are rare and mild and many peoples biggest fear are the needles.
As well as the quantitative effects Botox can have, such as a decrease in the severity and frequency of migraine attacks, theres also the little day to day things we often forget were missing out on.
Botox may help you to claim back hours previously lost to migraine, including:
- more quality time with friends and family
- less time off work and school
- ability to function better during a migraine attack
- head space to take on extra responsibility at work
- ability to pursue a passion project.
Botox isnt a quick-fix solution for chronic migraine and if it works, you need to continue treatment every 12 weeks for ongoing benefits. Botox isnt a cure, and like other migraine treatments such as preventatives, abortives and lifestyle changes, Botox is another piece of your treatment plan.
If you qualify for Botox on the PBS and youre prepared to spend more of your migraine budget, Botox can be a great treatment option for chronic migraine that can help to give you back more migraine free days.
Botox For Migraines At Hermann Aesthetics & Wellness
The experienced providers at Hermann Aesthetics & Wellness specialize in Botox treatments. We perform thousands of Botox injections per year and have the skills to administer injections in the precise areas that will benefit migraine sufferers.
For patients who have already been diagnosed with chronic migraines by another physician, we can review your previous care to determine if Botox treatment is right for you. If you havent yet been medically evaluated for your headaches, we recommend scheduling an appointment with Dr. Hermann. As a certified practitioner of internal medicine and a primary care physician, Dr. Hermann can determine whether your headaches are a sign of migraines. With a diagnosis, we can move forward with the proper treatment for your needs.