If you are one of the 36 million Americans who suffer from migraines, there is a breakthrough in treatment that you may want to discuss with your doctor. Commonly thought of as a wrinkle-reducer, Botox is approved by the Food and Drug Administration to treat those with chronic migraines. According to Robert Gilbert Jr., M.D., a neurologist at Piedmont Atlanta Hospital, Botox is a promising treatment option if you have chronic migraines.
Chronic vs. episodic migraines
The difference between chronic and episodic migraines is that chronic migraine sufferers experience headaches at least 15 days per month. A migraine is considered episodic when it occurs once every month or two, or up to three times per month. Treatment options differ depending on how often you experience headaches. “For an episodic migraine, we want to treat it with a drug that is going to help right away,” Dr. Gilbert says.
The physiological causes of a migraine headache
Women are more likely than men to be affected by migraines because of their estrogen levels. “We know that migraines tend to start around the time that menstrual periods start,” he says. “By age 30, about one in four females will experience a migraine.”
When a migraine occurs, “part of the cause is vascular,” Dr. Gilbert says. “We know there is a strong hereditary basis with migraines, and we know there are multiple triggers. What happens initially is that you get an activation of those nerve cells in the brain stem, in the trigeminal nucleus.
“This leads to the dilation of the vessel and also leads to the release of a lot of peptides that are inflammatory. Therefore, drugs that decrease the swelling of the vessels and anti-inflammatory drugs are the mainstay of treatment for acute migraines.”
A new treatment option
In 2010, the Food and Drug Administration (FDA) approved the use of Botox as a therapy for treating migraines. Dr. Gilbert confirms that the drug is effective in treating chronic migraines. However, experts are still unclear exactly how Botox works for treating migraines.
“Part of the action of Botox is that it inhibits some of the acetylcholine and relaxes the muscles, but that’s not the whole story,” he says. “It somehow must interplay with the trigeminal nucleus. We know that Botox must be injected bilaterally into the forehead as well as the neck, and that there are a certain number of units that must be used.”
Dr. Gilbert considers Botox to be a major breakthrough in how chronic migraines are treated. “It is one of the few FDA-approved drugs that is effective,” he says. “I’ve found that it is very helpful for the majority of patients we have treated.” For more information, visit Piedmont Neurology Services.
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