Migraine is a disabling disorder in terms of pain and loss of quality of life. Sufferers describe it as a nightmare, severely hampering their daily routine with the onset of nausea, lack of appetite, temporary blindness, blurred vision or eye pain, along with intense headache.
The usual management of this pathology includes a correct examination and clinical history, as well as pharmacological therapy both for the acute pain phase and sometimes, preventively, to reduce the frequency and intensity of the attacks.
Severe cases of headaches or migraines
Sometimes patients do not achieve pain relief with pharmacological therapy or it is insufficient. On the other hand, medication may not be suitable for some cases due to intolerance or contraindication due to concomitant diseases, i.e. a second pathology may arise. In these patients it is common for them to abandon pharmacological treatment due to the side effects it produces.
In severe or refractory cases, as well as in those where it is not reasonable to use oral medication for long periods of time, botulinum toxin can be used.
Treatment with botulinum toxin
The use of botulinum toxin for the treatment of headaches and migraines is supported by clinical trials that led to the approval of the technique by the Food and Drug Administration (FDA), provided it is performed by specialized personnel. The Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) study, published in 2014, endorses the safety of the treatment and establishes the protocol for the technique and frequency of administration.
As in all cases, it begins with a correct selection of the patient in order to adapt to the protocol. The administration pattern is clearly defined in the study, although in the hands of a properly trained specialist, variations in the doses and injection points can be made to suit the patient.
Botulinum toxin: procedure and results
The process of botulinum toxin infiltration in the Pain Unit lasts about 15 minutes and is performed on an outpatient basis. Most commonly, 155 IU of botulinum toxin is administered in 31 predetermined points that coincide with the trigeminal nerve endings, with a total of four sessions separated by at least three months. It is allowed, always under clinical indication, to use lower doses (100 IU in 20 points) if the specialist’s criterion finds it appropriate. It should be emphasized that the treatment should always be adapted to the patient in order to individualize it as far as possible.
The results are remarkable, showing a significant improvement of the disease in terms of reduction of the intensity, frequency and duration of migraine attacks. In addition, it significantly improves functionality and quality of life.
Side effects are not very important, the most frequent being neck pain. Other effects may occur, such as loss of strength in the eyelid, certain muscular weakness, etc., but they are less frequent and of short duration.
Botulinum toxin is the first approved intervention that has been shown to produce significant improvement in the disease. Although it is not a cure, it represents an important advance in the treatment of this disease.