Headaches & BOTOX

Cecile E.F. Becker, MDNeurology

www.SpringfieldClinic.com/DoctorIsIn

Headaches• Tension-type headaches• Chronic daily headaches• Secondary headaches• Medication Overuse headaches• Cluster headaches• Sinus headaches• Migraine headaches

Picture: blog.brainhq.com

Migraine Headaches• Common Migraine• Classic Migraine• Chronic Migraine• Basilar migraine• Complicated migraine• Ocular migraine• Abdominal migraine

Initiation of A Migraine

Picture: Craig Blackwell, M.D.

Genetics• 8% of children, 6% of men and 18% of women• Family history in 80% of migraine sufferers• Chromosome 19 for Familial Hemiplegic Migraine

Migraine headaches• Nausea and/or vomiting• Photophobia and phonophobia• Sensitivity to smell• Allodynia• Throbbing pain• Unilateral pain

Triggers• Cured, smoked or deli meat• Aged cheeses• Avocado, guacamole, bananas, dried fruit• Chocolate• MSG• Aspartame• Beer and wine• Caffeine

Treatments• Preventive medication• Abortive medication• Holistic approach• Non prescription medications

Preventive medication• Calcium channel and Beta blockers• Tricyclic Anti-depressants: Nortriptyline,

amitriptyline• Anti-epileptic medications: Topiramate, Valproic

acid, gabapentin• BOTOX injections

Abortive medications• Triptans: Sumatriptan, rizatriptan, zolmitriptan etc• Migranal nasal spray• Midrin• Fioricet• OTC’s: Ibuprofen, acetaminophen, Naproxyn,

Aspirin

Holistic Treatments• Accupuncture• Yoga• Diet modification• Butterbur, Magnesium, Riboflavin, and Co-enzyme

Q10• Exercise• Biofeedback• Relaxation therapy

Chronic migraines• Chronic Daily Headache for at least 3 months• More or equal to 8 days per month• Fulfils criteria for migraine without aura and/or

treated and relieved by triptans or ergots• There is no medication overuse or secondary

cause

Botulinum Toxin

Botulinum Toxin• 1793- Human outbreak linked to sausages• 1870- Disease named “botulism”• 1895- Organism isolated• 1944- Toxin isolated• 1949- Toxin blocks neuromuscular transmission• 1973- Animal experiments• 1980- Treatment of strabismus

Botulinum Toxin• Neurotoxin • Produced by Clostridium botulinum bacteria.• There are at least 7 types of botulism toxins: A, B,

C, D, E, F, and G.• Humans are affected by A, B, E and rarely F.

Botulism• Food borne botulism

Botulism• Food borne botulism• Intestinal botulism

Botulism• Food borne botulism• Intestinal botulism• Wound botulism

Botulism• Food borne botulism• Intestinal botulism• Wound botulism• Inhalation botulism

Mechanism of Action

Picture: Scientopia

Picture: Allergan

Cosmetic BOTOXPicture: Allergan

Other Available Botulinum Products

• MYOBLOC- Botulinum Toxin B• Xeomin- Botulinum Toxin A• Dysport- Botulinum Toxin A

BOTOX• First approved in 1989 for strabismus and

blepharospasm.• Approved in 2010 for Chronic migraine HA

Uses for BOTOX• Strabismus• Cervical Dystonia• Blepharospasm• Upper limb spasticity• Overactive Bladder• Excessive underarm sweating when anti-perspirants

fail• Chronic migraines

Botulinum Toxin• Blocks release of Acetylcholine• Blocks Substance P

Onset of action• 3-10 days• Results last for 3-6 months• Results frequently improve with subsequent

injections• Headache frequency is decreased by 9 headaches

per month

Who qualifies for BOTOX injections for migraine Headaches

• 18 years of age or older• 15 migraines per month or more• Lasting at least 4 hrs each time• Preventive medications were tried and ineffective• No contraindication

The injections• 31 small injections • 155-195 Units of BOTOX• Takes 5-10 minutes• Performed in the office

Picture: Allergan

Contraindications• If you are allergic• Neuromuscular diseases such as Myasthenia

Gravis or ALS• Infection at the injection site.

Side Effects• Eyelid drooping• Bleeding• Bruising• Head drop• Weakness• Infection

Side Effects• Muscle weakness• Difficulties swallowing• Difficulties breathing• Double vision and blurry vision• Pain at the injection site.