Botox injection

4 November 2019

Combining CGRP Inhibitors with – Botox

Now that some of the new CGRP inhibitors have hit the market, studies are beginning to see how they might work with together with other treatments. At the University of Utah, the treatment includes Botox (onabotulinumtoxinA or ONA) and Aimovig (erenumab).

The patients trying the combination treatment, in this case, had already tried 3, 4, 5, or more treatments without success. Many also suffered from depression, anxiety, insomnia, and other co-morbid disorders. Most, though not all, were women.

Both ONA and the CGRP inhibitors such as Aimovig are given by injection. Botox every 12 weeks, Aimovig every 4. (The upcoming drug eptinezumab is meant to be given every 12 weeks, so it would be interesting to see how that works with ONA as well.)

The benefits of ONA are known to be inconsistent over the 12 weeks between treatments. In other words, there may be days, especially near the end, when it’s not helping the way it did at its peak. So combining it with another medication may help the situation.

In this study, which is small but ongoing, the results were not spectacular but they were promising for some patients. Slightly more than half of the patients did see significant improvement with the combination. The bulk of the rest found no improvement, although 18% found that their “headache burden” actually got worse.

So once again this is a treatment that may be a tremendous benefit to some patients. And remember, these were generally patients who have tried several other treatments without success.

One of the biggest challenges when it comes to combination treatment, and combination treatments that work with many but not all patients, is insurance coverage. It is in the best interest of insurance companies in many cases to see stable improvement of migraine symptoms. But convincing them that this is the way to go may take time.

We would be interested to hear your comments if you have tried any of the new CGRP inhibitors in combination with Botox treatment. Leave a comment!

6 November 2013

Migraine – Botox – And Funny Eyebrows

James Medications, Tips, Treatments 6

Have you ever wondered why some people who have had Botox (botulinum toxin A) treatment have strange looking eyebrows?

It’s called the Mephisto Sign, or perhaps Mr. Spock Eyebrows. Basically, one or both eyebrows arch, making the patient look – surprised, all the time. And they probably are.

This is a possible problem for migraine patients when they receive injections in the forehead. What happens is, the frontalis muscle of the forehead becomes hyperactive, causing the eyebrows to arch. You can see an example of the Mephisto sign from Botox here.

Fortunately, even if this happens it can usually be fixed. Another injection to the lateral-most point (the outer part) of the frontalis muscles should fix the problem, although you may still be waiting a few days.

Although a pretty minor problem compared to chronic migraine pain, the Mephisto sign can be a pretty annoying problem, as well as a dead giveaway that someone has had Botox treatment, for whatever reason.

It’s just another reminder that you need to make sure you’re going to a specialist experienced in Botox (or Dysport or Xeomin) migraine treatment. Make sure they keep a careful record of exactly where you have been injected each time. And do return to them if you have any problems with your treatment, including eyebrows that won’t behave.

Here’s some more information about How to be Safe with Botox (10 tips).

Also see A proposal to prevent the “mephisto sign” side effect of botulinum toxin type a injection in chronic migraine.

27 March 2013

How to be Safe with Botox (10 tips)

James Tips, Treatments 12

Although many people are injected with Botox (onabotulinumtoxinA) (botulinum toxin type A) and they never have any significant problems, there have been cases of severe health issues.

Only receive injections from a professional trained and experienced in using Botox for migraine. Many problems can be solved simply by visiting someone who knows what they’re doing.
Be sure the doctor knows your medical history. This includes your experience with migraine, any previous Botox treatments, previous surgeries, any medications you take (including sleeping pills, allergy medication, blood thinners, antibiotics and muscle relaxants) etc.
If you have infection, muscle weakness, or inflammation where you’re going to be injected – wait for another day.
Tell your doctor if you have experienced any side effects from a previous treatment.
Check the ingredients – if you have an allergy to any ingredients in the injections, don’t have the treatment.
Do not start any new medications without telling your doctor that you’ve had Botox treatments in the past.
After the treatment, tell your doctor immediately if you’re experiencing any of these side effects: itching or rashes, trouble breathing, trouble swallowing, drooping eyelids or drainage from your eyes, vision problems (double vision or blurred vision), heart problems or chest pain, muscle weakness or paralysis, loss of bladder control, trouble talking or hoarse voice. Note that some of these symptoms could appear several weeks after your treatment.
If you are pregnant, trying to get pregnant, or breastfeeding, discuss the risks with your doctor.
Be aware that Botox could cause migraine-related symptoms. These include headache, fatigue, anxiety, and pain in other parts of the body. Hopefully you won’t experience these symptoms. However, do discuss the pros and cons with an experienced doctor before starting treatment.
Botox should not be the first treatment you try for chronic migraine. Look at other options first – not only medications, but also non-drug treatments. If your doctor recommends Botox treatment when you’ve first been diagnosed, get suspicious and seek a second opinion

Please remember that these are not reasons why no one should ever try a Botox treatment. As with just about any treatment for migraine, there are pros and cons. Being aware of them helps you to have the safest and best options without making things worse.

For more, read about Botox headache injections here.
See what Allergan (the makers of Botox) has to say about Botox safety

25 November 2011

Canada: Botox Approved for Chronic Migraine

James News, Treatments 1

In a step forward for Botox in Canada, Health Canada approved Botox (onabotulinumtoxinA) for treatment of chronic migraine.

It was a step back for the makers of Botox in the country (Allergan Canada) back in 2009 when Health Canada began warning patients that Botox could spread to other parts of the body in some cases ("distant toxin spread"). However, for many patients the benefits still outweigh the risks.

Although it hasn’t been the magic bullet for chronic migraine sufferers, it has provided significant relief for many. But that relief comes at a cost – no, quite literally – the treatment tends to be very expensive.

It is hoped that, as the official agencies in various countries recognize the benefits of Botox, that insurance companies will as well. If Botox can significantly cut down on migraine attacks and symptoms, it’s in the best interest of insurance companies to cover the treatment.

Again, this approval is for those with chronic migraine, not those who have an attack once a month. The treatment involves injecting small amounts of Botox beneath the skin, usually around the forehead and temples, and sometimes other locations such as the neck. Learn more about Botox injections here.