Migraine (also called migraine) is a special form of headache. It most often affects young and middle-aged women, but also men.
The pain is usually in the form of intense “throbbing” in the orbital area or forehead, extending to one side of the skull (“hemicrania”), or throughout the head. In addition, it may be accompanied by nausea and vomiting.
Sometimes the headache is preceded by vision of luminous points, difficulty to see half of the visual field, transitory difficulty to speak, sensation of corkiness in the face or in an arm; in what is known as migraine with aura, which lasts less than one hour.
Duration of migraine
The duration of the migraine is usually several hours or even days and, in general, it is better lying down in the dark and without noise. Its frequency is very variable depending on the patient, but usually one or two migraines per month.
In migraine there is usually a family history and a certain relationship with menstrual hormones. In addition, stress, atmospheric changes, weekend relaxation, alcohol, tobacco and some foods (cured cheeses; red wine; chocolate; nuts) can be triggers.
Diagnosis and treatment of migraine
Migraine is diagnosed clinically. It is made on the basis of the symptoms reported by the patient to the neurology specialist, and the neurological examination is normal (apart from when the patient is suffering a migraine with aura). Neuroimaging tests (CT, MRI) are normal but serve to rule out other headaches secondary to intracranial lesions.
As for the treatment of migraine, it is not curative. There are basically two types:
- Preventive; to reduce the number of migraine attacks.
- Symptomatic; to relieve pain at the time of the migraine.
As symptomatic treatment for the improvement of acute pain we have the usual analgesics, such as anti-inflammatory drugs; while for more intense forms we have triptans, which can improve the headache and many of the accompanying symptoms in a migraine (nowadays it is the treatment of choice to mitigate the pain). Some of them are in flash form and others in liotab (so that no water is needed to avoid triggering vomiting).
This is a group of specific drugs for the treatment of migraine pain that should be taken at the onset of pain; in case of migraine with aura, they should be started when the aura subsides.
As for preventive treatment, this should be applied when the frequency of migraines is high (more than 1 per week) and there are several possibilities. For example, botulinum toxin is recommended when other medications have already been tried without results and in the case of a very frequent migraine with chronic characteristics.
Botulinum toxin for migraine headaches
Botulinum toxin (commercially known as Botox) is indicated for the preventive treatment of “chronic migraine”. The indication is given when there are 8 or more intense migraines per month, in spite of the usual treatment (previously mentioned).
Five units of toxin are injected in each of the 35 points of the scalp of the head (according to an established protocol). The injections are subcutaneous and performed with a very fine and small needle, and are well tolerated.
The protocol is performed every 3 to 4 months. If during the first year improvement is observed in the patient, the treatment is repeated indefinitely.
In recent years, an average of 60% improvement in the frequency and intensity of chronic migraine has been observed with this treatment.
This treatment has no significant risks. In fact, it produces hardly any side effects and they are always transitory.
Advantages and disadvantages of botulinum toxin for migraine
Botulinum toxin in migraine can reduce or avoid oral medication and its possible unpleasant effects (as well as its cost). The effect is long lasting (3 or 4 months). Moreover, the technique is easy, it is performed in an outpatient clinic without prior preparation and in 15 minutes.
The action of this treatment is local (it is believed that at the level of the cutaneous pain receptors of the head) and, therefore, it does not produce unpleasant systemic effects (since it is not distributed throughout the body as happens with oral drugs).
The disadvantage of botulinum toxin is the price, but taking into account that the protocol would only have to be used 3 or 4 times a year, and that the cost of other drugs that could be stopped is amortized, in the end it becomes profitable for the patient with these characteristics and for the public health system.