I can say one thing about botox for migraine prevention. It certainly does not work right away. I am not about to give up hope that it will work, but let’s just say so far I have been enduring three days of nasty migraines. If you say 10 is the worst migraine I have ever experienced, then I have been on average a 7.5 these last three days… well beyond functioning. So no decrease in intensity so far nor even frequency.
If you are curious how getting a neurotoxin injected into your head muscles, rather than say directly into the brain, would have any effect on migraines there is actually no clear answer. I can understand how certain drugs affect migraines… affect the excitation of neurons firing and then the inflammation of blood vessels. But botox? Don’t get it. Maybe for tension headaches. Anyway here is what I found about the how:
“Why does it work?Based on the mechanism of action of Botox, it is unlikely that anyone would have thought to try it for migraines. Its success in treating some patients has caused problems for those who would attempt to explain why it would work in migraine. One possibility is that muscle tension may act as a trigger for migraine in the same way that light and odors do. By reducing muscle tension, Botox would be eliminating an irritant to the nervous system, which would then reduce the chances of a migraine developing. More recently, studies have shown that Botox may affect other nerve cell signallng systems that have to do with the perception of pain. In an animal model of pain, injection of Botox under the skin resulted in decreased response to painful stimuli. Traditionally, scientists have thought that the pain of migraine was due to swelling and inflammation of blood vessels, but perhaps muscle tension is more of a factor than previously appreciated.”- unknown source
So in other words who knows? Based on this explanation I can be certain it will not help with my monster migraines, where certainly the pain is not reflected in my scalp.
Research suggests it can reduce frequency and intensity:
Two Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials recruited 1384 patients with chronic migraine, and randomised them to treatment with Botox® or placebo. These patients were suffering on average 20 days of headache each month, of which 18 were moderate or severe. Those randomised to Botox® received fixed-site, fixed dose injections every 12 weeks over 56 weeks. These injections covered seven specific areas of the head and neck, with a total dose of between 155-195 units. At six months, after two cycles of treatment, those treated with Botox® had on average eight less days of headache each month. After 12 months, 70% of those treated had ≤50% the number of headaches that they had done originally. Botox® was well-tolerated, the commonest side effects being neck pain (6.7%), muscular weakness (5.5%), and drooping of the eyelid (3.3%). No serious irreversible side effects have ever been reported in trials of Botox® in headache. migraine trust
Anyway, needless to say, I am not in a good mood. At least the Toradol is sitting well with me right now, cause the last thing I need is pain from that. I have one week before I go back to work and I am fine with that as long as I get some slight indication this botox is doing something… anything. Even if it just does a little, we can add to that with other preventatives.