Botox

18 June 2011

Corrugator muscle surgery and the Migraine Trust

This month the Migraine Trust issued a press release regarding "corrugator muscle surgery". Wendy Thomas, the CEO for the Migraine Trust, went on record to say that they would not recommend this type of surgery for migraine. The main reason was "insufficient evidence" that this type of surgery is effective.

Some researchers have suspected that there is evidence that this type of surgery may help people because of the way Botox has helped some with chronic migraine. Is Botox impacting the muscles in a temporary way, and if so can surgery make the improvement permanent?

Of course, saying that there’s generally "insufficient evidence" does not mean that this type of surgery never works, and it does not mean that it might not be a promising area of research. But there are some reasons why we can’t jump too quickly onto the bandwagon.

First, we don’t know exactly why Botox works. We can’t assume that we know, because there are a number of complex biological changes happening in Botox treatment.

Second, there has been a very limited amount of research done in this area.

Third, we need to remember that this type of surgery, if it does work in a widespread way, is likely eliminating a trigger, but not a cause. That means that the migraine attacks could return after surgery, even if it isn’t right away.

On the other hand, just because this is not a treatment for the majority of migraine patients at this point, we shouldn’t completely abandon the research. It’s one thing to point out to patients that there are many better options to try, it’s another thing to jump to the conclusion that there is no promise in this area of research at all.

Remember that there are many, many treatments available, and also many, many lines of research in this day and age. This should never be the "only hope" of future treatment for a migraineur.

30 May 2011

Could Botox Fight Low Cerebrospinal Fluid Pressure Headaches?

James Uncategorized 0

Low Cerebrospinal Fluid Pressure Headaches can be tricky to diagnose and difficult to treat. Could Botox (Botulinum Toxin A) provide relief for some?

Low CSF pressure can lead to other neurological symptoms besides just headache (such as nausea, neck pain, neck stiffness, vertigo, and visual disturbances). But the headaches can be anywhere from nagging to completely disabling. The dehydration after a night of drinking can actually change levels of the fluid, leading to a hangover headache.

Needles used for a lumbar puncture

But low CSF headaches generally come after a lumbar puncture, which makes them easier to track down. However, some people have low CSF pressure for other reasons. If the low pressure is suspected, tests can usually lead to the proper diagnosis and treatment. If.

Common treatments include bed rest and re hydration, epidural blood patch (an injection of your own blood at a key location), and some types of surgery.

A recent case study on Botox published by the Mayo Clinic has raised interest in using Botox for chronic cases. In this case, a women who had been suffering the pain of low CSF headache for 25 years found preventative relief from Botox injections. The intensity of her headaches went from 8/10 to 3/10 for the three months after the treatment.

This raises new questions about what triggers the headache pain, and how Botox fights it. But this new treatment may allow other patients that have not found treatments to live a normal life.

11 February 2011

Dr. Guyuron’s Migraine Surgery, 5 Years Later

James Discoveries & Stats, Treatments 7

Back in June of 2005 we were talking about a surgery for migraine disease being pioneered by Dr. Bahman Guyuron. Dr. Guyuron has been involved in surgical procedures in the USA and Canada for many years, most notably in the area of plastic surgery. It was while he was doing plastic surgery that he discovered that some of his patients were finding relief from their migraine attacks.

So he tested a surgical technique to target some trigger areas for migraine. First, each patient is "tested" with botulinum toxin A (Botox). The Botox treatment confirms the target sites.

Then comes the main surgery. The surgery removes tiny bits of muscle or nerves in the head, to relieve the pressure on certain nerves, thus eliminating triggers in some people. Sometimes other minor procedures are used.

69 of Dr. Guyuron’s patients were followed up throughout the following five years. The results are looking good.

These are, of course, very good results. Now, it should be noted that only certain patients would be approved for this type of surgery. However, it is likely that most of these patients had tried many other things without success.

Also, 10 patients (out of 79) were removed from the study because they required further surgery (they’re not included in the above chart).

Usually, surgery is not recommended for migraine. You will try many of the other options available before you should even consider surgery. Dr. Guyuron himself looks for people who have at least two or three severe attacks each month that do not respond to medications.

The recovery time for this surgery is about two to three weeks. As with any surgery, there is some risk, but problems with procedures like this tend to be rare.

Incidentally, we recently talked about Dr. Guyuron for another reason. He’s the man behind Innovative Medical Equipment, the company that has developed the SootheAway Continuous Thermal Therapy Device.

Read more about Dr. Bahman Guyuron here. If you want to read more about this particular study, check out this article at WebMD – Cosmetic Surgery May Also Treat Migraines.

16 October 2010

Breaking News: Botox approval from FDA

James News, Treatments 6

Yesterday the FDA in the United States officially approved Botox for use with chronic migraine patients. This follows a similar approval in Britain for Botox this past summer.

This is a continuation of an up-and-down roller-coaster ride for the controversial treatment. Read more in the New York Times article: Botox Shots Approved for Migraine.

This from the FDA:

To treat chronic migraines, Botox is given approximately every 12 weeks as multiple injections around the head and neck to try to dull future headache symptoms. Botox has not been shown to work for the treatment of migraine headaches that occur 14 days or less per month, or for other forms of headache. It is important that patients discuss with their physician whether Botox is appropriate for them.

The most common adverse reactions reported by patients being treated for chronic migraine were neck pain and headache.

OnabotulinumtoxinA, marketed as Botox and Botox Cosmetic, has a boxed warning that says the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism. Those symptoms include swallowing and breathing difficulties that can be life-threatening. There has not been a confirmed serious case of spread of toxin effect when Botox has been used at the recommended dose to treat chronic migraine, severe underarm sweating, blepharospasm, or strabismus, or when Botox Cosmetic has been used at the recommended dose to improve frown lines.

Side effects have been rare with Botox treatment, but you are wise to find someone experienced giving Botox injections for migraine, referred by a doctor who knows your medical history.

More on an overview of Botox for Migraine, and a little more detail about what a Botox treatment is like.

Check out more about Botox in these posts.

24 March 2010

Two Botox Studies Published (and it’s good news for Botox)

James Medications, News, Treatments 0

On March 17th 2010, the journal Cephalalgia published two studies on Botox from the PREEMPT 1 and 2 trials. These are both phase 3 studies, and it’s still looking good for Botox.

Both of the trials were for chronic migraine sufferers. The patients were given Botox injections every 12 weeks.

The PREEMPT 1 trial found a significant decrease in days with headache and migraine, hours of headache and moderate to severe headache days. Though actual number of attacks were not significantly lessened, the attacks were lessened quite a bit.

The PREEMPT 2 trial also found a significant decrease in headache days within a 28 day period.

More good news – very few patients had problems with the injections (ie side effects) that were significant enough that they stopped the trial.

One proponent for Botox use in migraine treatment is Dr. Alexander Mauskop of the New York Headache Center. He writes that he’s hoping to see FDA approval (in the USA, of course) for Botox before the end of the year.

Stay tuned.