A migraine is essentially defined as a throbbing or pulsating headache that is limited to one side of the head (a unilateral headache). They are usually characterised by severe pain and are accompanied by nausea and hypersensitivity to light and sound. The exact causes of migraines are scientifically unclear, but certain triggers have been recognised that mark the onset of a migraine attack. A migraine is also often preceded by a sensory warning sign. Known as an ‘aura’, these include flashes of light, blind spots or tingling in the arm or leg.
Three times as many women are affected by migraines than men. Some people may have several migraine attacks in a month, while others will only suffer from a few throughout their whole lives. They occur at any age, but are most likely to begin between the ages of 10 and 40, diminishing after the age of around 50.
Botox (Botulinum Toxin A)
Patients that have easily identifiable trigger points, permanently contracted muscles, or headaches that are associated with muscle spasms are very good candidates for Botulinum Toxin A injections. Botox is the industry name for Botulinum toxin type A, which is derived from a strain of bacteria called Clostridium Botulinum. When Botox is injected into a muscle, it blocks the signals sent from the brain which tell the muscle to contract. Botox targets the muscles involved by effectively disarming them and ensuring that they do not send panic signals throughout the body. The body believes that there is no pain being experienced. Botox can help to keep the muscle relaxed for anywhere from three to six months, after which it is hoped that the muscle will be able to contract normally without pain or spasms.
Botox may also be used to treat migraines. The injections are given into the muscles at the back of the neck, the forehead and the temples, to prevent the production of signals that cause you to feel pain. However, this treatment is only recommended for people with chronic migraines when medication has been unsuccessful.
Botox injections are performed as an outpatient procedure at the London Pain Clinic, with patients free to leave as soon as the treatment has been administered. Initially, the treating doctor will spend time identifying the individual trigger points, sometimes with the help of a physiotherapist, and will mark the areas with a pen. The located areas will then be sterilised with a chlorhexidine antiseptic spray and a fast acting local anaesthetic will be will injected through a small cosmetic needle.
The Botox can then be administered by one of three different ways, depending on the case. Small cosmetic needles are usally preferred, but a Stimuplex nerve stimulator or ultrasound guidance are sometimes necessary if the trigger points are more difficult to access. 100 units of Botox are usually administered, but this can increase up to 200 units depending on the affected area.
One of the major advantages of Botox is that there is little or no recovery time, and most people feel fine and can return to their normal life immediately. The results of treatment should last around 3-6 months and the procedure can be repeated after this time.