What are migraines?
A migraine is usually a moderate or severe headache felt as a throbbing pain on 1 side of the head. Many people also have symptoms such as feeling sick, being sick and increased sensitivity to light or sound.
Migraine affects approximately 2% of the world population. It is estimated that 190,000 people in the UK suffer migraine every day, and there are reportedly 6 million sufferers in the UK. Prevalence has been reported to be 5-25% in women and 2-10% in men.
Migraine can have a devastating effect on patients physical, social, emotional and working life. Migraine is the main reason for absence from work and decreased quality of life. The word migraine derives from the Greek work ‘hemicrania’ which means ‘half the skull.’
There are different subtypes of migraine, some of the most common types are:
• Episodic migraine:
-With aura: various sensory and visual changes
• Chronic Migraine: Having headaches more than 15 days a month.
• Hemiplegic Migraine: Rare condition involving temporal weakness
• Menstrual Migraine: timings of the attack linked to the menstrual cycle.
What is Botulinum Toxin, commonly referred to as ‘Botox’?
Botulinum Toxin is a purified protein that works by temporarily relaxing muscles, by preventing the release of a substance called acetylcholine which is responsible for muscle contraction. The effects last for 3-4 months when new receptors to acetylcholine start forming.
Contraindications to BoTN:
• Concurrent Antibiotics use
• NSAIDS, i.e ibuprofen, aspirin, Vitamin E (to be avoided one week before and after the procedure)
• Neuromucuslar disorders i.e. Myasthenia Gravis, Lambert Eaton Syndrome
• HIV and Immunodeficiency
Pathophysiology of Migraines:
Migraines are caused by hyperexcitation of the trigeminal peripheral sensory neurons by peripheral stimulation such as light, sound, stress or any other stimulus. These peripheral stimuluses then stimulate the protective lining of the brain otherwise known as the ‘meninges’ which have trigeminal innervations. These signals then travel to the Central Nervous System, through to the Trigeminal Nucleus, Thalamus and then to the pain centre in the brain causing migraine headaches and symptoms.
The way Botulinum Toxin (BoTN) treats migraine is by decreasing the excitation of the peripheral sensory nerves. Normally the neurotransmitters, Glutamate and CGRP are released from the presynaptic terminal and bind to the nociceptors on the postsynaptic terminal to allow transmission of the pain signal. BoTN cleaves the SNAP25 protein that is part of the Snare complex which is required to release the neurotransmitters from the presynaptic terminal, thus preventing the transmission of the pain signal.
The main nerves we inject into are trigeminal, cervical and the occipital nervous system. We also inject into seven muscles which are: Procerus, corrugator, frontalis, temporalis, occipitalis, paracervicalis and trapezius. The combination of inhibiting these muscular contraction along with reducing the peripheral nervous system hyperexcication is the main mode of treatment in how BoTN works to reduce the severity of migraine headaches.
‘Botox’ treatment can be used to treat episodic and chronic migraines as well another type of headache known as tension headaches. Tension headaches are the most common type of headaches and are referred to as ‘stress headaches.’ Symptoms include a band, tightness, or pressure sensation around the head. Typically pain is in the forehead and temples and sometimes at the back of the head.
Post treatment advice:
• Avoid alcohol for 24 hours
• Avoid lying flat for 4 hours
• Avoid exercise, excessive heat for 4 hours
• Don’t touch or rub the treated areas
• Contract the muscle injected without rubbing or touching it.
We will discuss the procedure in detail with you on consultation. The cost of the procedure is £750. Each cycle of treatment lasts for 3 months.
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