Typically the word ‘Botox’ would conjure up images of C List celebrities with too much fake tan, lying back on a couch on some unreal reality TV programme. But this toxin has other qualities that sufferers from chronic migraines can now benefit from. The National Institute for Health and Clinical Excellence (NICE) has finally recommended Botox as a medical treatment for preventing chronic migraine. There are stipulations however; you have to have headaches on at least 15 days every month, at least on eight days of these days these headaches are migraines and you have tried at least three different preventive drug treatments which have not alleviated the symptoms.
As a chronic migraine sufferer myself, I can tell you exactly how debilitating these headaches are. From the pulsating agony of the sharp hammer blows that pierce through your head, concentrating on a spot behind one eye, to the rising nausea every time you attempt to get up. My worst migraine lasted four days in which for two of those days I was sick every half an hour and only got up to replenish a pint glass of water so that I would not be dry retching in half an hours time. That is a migraine as all sufferers know; they are not typical headaches, but do we know what causes them and why do conventional pain killers not appear to work?
Migraines are thought to start by changes in the brain and can be triggered by all number of reasons such as too much or too little sleep, certain foods, bright lights, even changes in the weather and stress. Researchers now believe that migraines are linked to expanding and constricting blood vessels on the brain’s surface. It seems that there is a migraine ‘generator’ in the brain that when activated by a trigger, begins to signal to hyperactive nerve cells to send out impulses to the blood vessels. This causes them to close in on themselves, or constrict, which is followed by rapid dilation in which they expand and this then releases chemicals such as serotonin and other inflammatory substances that cause these pulses of the blood vessels to be painful. There are specific drugs that actually work but they are not your normal pain killers, they are called triptans and they offer relief for migraines because they narrow (constrict) these pulsating blood vessels in the brain and therefore relieve the painful swelling. Triptans also help to treat migraine symptoms as they reduce any neurogenic inflammation.
Triptans, however, do not work for all migraine sufferers and this is where Botox could be particularly beneficial to people that endure these type of headaches on a regular basis. It is thought that by using Botox, the muscles around the head are relaxed and therefore blood pressure is reduced within the brain. It is also thought that Botox might reduce the nerves’ ability to send pain signals during a migraine. Dr Fayyaz Ahmed, chair of the British Association for the Study of Headache (Bash) commented on the NICE declaration, “The headache experts with first-hand experience in treating chronic migraine know how debilitating the condition can be for some patients and Botox can be a life-changing treatment. The medical evidence shows that Botox can provide significant benefit to patients with chronic migraine, helping to reduce the number of days disrupted by migraine or headache and improving their quality of life.”
And Prof Carole Longson, the director of the health technology evaluation centre at NICE, was quoted from the BBC as saying. “We are pleased that the committee has been able to recommend Botox as a preventative therapy for those adults whose headaches have not improved despite trying at least three other medications and whose headaches are not caused by medication overuse. Although Botox may not be effective or appropriate for all patients with chronic migraine, the Migraine Trust and Bash believe that it should be available on the NHS for those patients who have been unable to manage their condition with preventative medication and who are most likely to respond to the treatment.”
It is expected that the Botox for chronic migraine treatment will become available on the NHS some time in the beginning of August 2012. It will cost the NHS £349.40 for a 12-week cycle, and sufferers will receive injections in their head and neck. In the meantime, if you suffer from migraines there are some OTC pain relief that contain triptans that I have found to be very effective. Imigran is available from most chemists but you do have to fill in a questionnaire so that they can distinguish exactly what type of headache you are suffering from. It is not recommended for ordinary headaches as it affects the blood vessels. See our previous article on migraines here for more information.