Botox® for Migraine

Available at our Multi-Award Winning Clinics in Dublin & Cork

Does This Describe You?

  • You are struggling with migraines and not sure what to do or who to ask?
  • You are frustrated that your migraines are stopping you from doing the things you love?
  • You are having difficulty sleeping because of migraines and this is affecting your energy and well being during the day?
  • You are taking painkillers or other medication for your migraines and would like to stop?
  • You are starting to worry that this isn’t ever going to get better as your migraines are getting more frequent and taking longer to go?

Here at Ailesbury Clinic, our highly experienced medical team are dedicated to helping migraine sufferers just like you, get back to doing the things you love without worrying about migraines.

What Are Migraines and why aren't yours getting better?

A migraine is a common problem that can produce pain around the:

  • Eyes
  • Temples
  • Both sides of the head
  • Neck area

Some migraine sufferers will also experience sensitivity to light, nausea, dizziness and other gastro-instestinal symptoms.

Most migraines will last for anything from 30 mins to a several days and are often severe enough to stop you going about your normal activities.

Migraines often occur as a result of many different factors such as stress, fatigue, neck or jaw tension or dehydration. If all of these factors are not addressed, then migraines can just keep coming back.

Our Migraine Solution Program

Here at Ailesbury Clinic, we have helped many patients with our 3 Step Migraine Solution Program.

1) Comprehensive Consultation

    Our knowledgeable and experienced team will take all detailed history of your migraines to discover the intensity, frequency, triggers and discuss any previous treatment you may have tried.

2) Injection Therapy

Targeted injection therapy is an effective approach to the pain and inconvenience of migraines.

Specific muscles around your head are targeted to break the cycle of migraines including:

  • bridge of the nose
  • forehead
  • temples
  • back of the head
  • neck

3) Breaking the cycle

  • Get back to normal and feel like yourself again
  • Get back to the gym
  • Sleep through the night without waking with a migraine

Our 3rd step is vital to make sure that the cycle of migraines has been broken, so you can get back to doing the things you love without pain or restriction or worrying about your migraines returning.

Ongoing maintenance treatment is often recommended.

The Science behind the Treatment

Botulinum toxin (onabotulinum toxin A) was licensed specifically for the treatment of chronic migraine in July 2010 by the Irish Medicines Board and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

Seven different subtypes of botulinum toxin (A-G) are known. A highly dilute preparation of botulinum toxin type A (Botox®) was introduced in clinical practice in the 1970s and 1980s to treat squint and blepharospasm. Other botulinum toxin preparations are available, both of type A (Dysport and Xeomin) and type B (Neurobloc or Myobloc), but these have never been tested in headache disorders.

Seven different subtypes of botulinum toxin (A-G) are known. A highly dilute preparation of botulinum toxin type A (Botox®) was introduced in clinical practice in the 1970s and 1980s to treat squint and blepharospasm. Other botulinum toxin preparations are available, both of type A (Dysport and Xeomin) and type B (Neurobloc or Myobloc), but these have never been tested in headache disorders.

In the mid-1990s a number of people reported improvement in headaches in patients receiving botulinum toxin for other reasons. Well-conducted clinical trials of botulinum toxin in various types of headache followed, but the results were disappointing, with no difference over placebo being found in tension-type headache, episodic migraine, and undifferentiated chronic headache. Detailed analysis of the results suggested, however, that there might be a subgroup of patients with chronic migraine who could benefit, and further trials were undertaken.

Two Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials recruited 1384 patients with chronic migraine and randomised them to treatment with Botox® or placebo. These patients were suffering on average 20 days of headache each month, of which 18 were moderate or severe. After 12 months, 70% of those treated had ≤50% the number of headaches that they had done originally. Botox® was well-tolerated, the commonest side effects being neck pain (6.7%), muscular weakness (5.5%), and drooping of the eyelid (3.3%). No serious irreversible side effects have ever been reported in trials of Botox® in headache.

Only patients with chronic migraine are eligible for treatment with Botulinum toxin. Chronic migraine is defined as headaches occurring on 15 or more days each month, at least half of which have migrainous features. There are, however, other treatments available to patients with chronic migraine, and it is important that patients have an informed discussion of their headaches and the options for treatment with a practitioner experienced in the diagnosis and management of headaches before a decision to use Botox® is taken.

The simple answer is that we don’t know fully. A recent US study by Rami Burstein et al using animal models suggested that botulinum toxin inhibits pain in chronic migraine by reducing the expression of certain pain pathways involving nerve cells in the trigeminovascular system. The trigeminovascular system is a sensory pathway thought to play a key role in the headache phase of a migraine attack.

Only patients with chronic migraine are eligible for treatment with Botulinum toxin. Chronic migraine is defined as headaches occurring on 15 or more days each month, at least half of which have migrainous features. There are, however, other treatments available to patients with chronic migraine, and it is important that patients have an informed discussion of their headaches and the options for treatment with a practitioner experienced in the diagnosis and management of headaches before a decision to use Botox® is taken

At present, the use of Botox® is restricted to a few specialist headache centres, but as time goes on there should be increasing numbers of trained injectors available. In all cases, however, you should ensure that the person injecting has received appropriate training, both in the diagnosis and management of chronic migraine.
Dr Treacy has a long experience with Botulinum toxin and Migraine and has lectured on this subject since 2003

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