Headaches & Botox
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Transcript of Headaches & Botox
Headaches & BOTOX
Cecile E.F. Becker, MDNeurology
www.SpringfieldClinic.com/DoctorIsIn
Headaches• Tension-type headaches• Chronic daily headaches• Secondary headaches• Medication Overuse headaches• Cluster headaches• Sinus headaches• Migraine headaches
Picture: blog.brainhq.com
Migraine Headaches• Common Migraine• Classic Migraine• Chronic Migraine• Basilar migraine• Complicated migraine• Ocular migraine• Abdominal migraine
Initiation of A Migraine
Picture: Craig Blackwell, M.D.
Genetics• 8% of children, 6% of men and 18% of women• Family history in 80% of migraine sufferers• Chromosome 19 for Familial Hemiplegic Migraine
Migraine headaches• Nausea and/or vomiting• Photophobia and phonophobia• Sensitivity to smell• Allodynia• Throbbing pain• Unilateral pain
Triggers• Cured, smoked or deli meat• Aged cheeses• Avocado, guacamole, bananas, dried fruit• Chocolate• MSG• Aspartame• Beer and wine• Caffeine
Treatments• Preventive medication• Abortive medication• Holistic approach• Non prescription medications
Preventive medication• Calcium channel and Beta blockers• Tricyclic Anti-depressants: Nortriptyline,
amitriptyline• Anti-epileptic medications: Topiramate, Valproic
acid, gabapentin• BOTOX injections
Abortive medications• Triptans: Sumatriptan, rizatriptan, zolmitriptan etc• Migranal nasal spray• Midrin• Fioricet• OTC’s: Ibuprofen, acetaminophen, Naproxyn,
Aspirin
Holistic Treatments• Accupuncture• Yoga• Diet modification• Butterbur, Magnesium, Riboflavin, and Co-enzyme
Q10• Exercise• Biofeedback• Relaxation therapy
Chronic migraines• Chronic Daily Headache for at least 3 months• More or equal to 8 days per month• Fulfils criteria for migraine without aura and/or
treated and relieved by triptans or ergots• There is no medication overuse or secondary
cause
Botulinum Toxin
Botulinum Toxin• 1793- Human outbreak linked to sausages• 1870- Disease named “botulism”• 1895- Organism isolated• 1944- Toxin isolated• 1949- Toxin blocks neuromuscular transmission• 1973- Animal experiments• 1980- Treatment of strabismus
Botulinum Toxin• Neurotoxin • Produced by Clostridium botulinum bacteria.• There are at least 7 types of botulism toxins: A, B,
C, D, E, F, and G.• Humans are affected by A, B, E and rarely F.
Botulism• Food borne botulism
Botulism• Food borne botulism• Intestinal botulism
Botulism• Food borne botulism• Intestinal botulism• Wound botulism
Botulism• Food borne botulism• Intestinal botulism• Wound botulism• Inhalation botulism
Mechanism of Action
Picture: Scientopia
Picture: Allergan
Cosmetic BOTOXPicture: Allergan
Other Available Botulinum Products
• MYOBLOC- Botulinum Toxin B• Xeomin- Botulinum Toxin A• Dysport- Botulinum Toxin A
BOTOX• First approved in 1989 for strabismus and
blepharospasm.• Approved in 2010 for Chronic migraine HA
Uses for BOTOX• Strabismus• Cervical Dystonia• Blepharospasm• Upper limb spasticity• Overactive Bladder• Excessive underarm sweating when anti-perspirants
fail• Chronic migraines
Botulinum Toxin• Blocks release of Acetylcholine• Blocks Substance P
Onset of action• 3-10 days• Results last for 3-6 months• Results frequently improve with subsequent
injections• Headache frequency is decreased by 9 headaches
per month
Who qualifies for BOTOX injections for migraine Headaches
• 18 years of age or older• 15 migraines per month or more• Lasting at least 4 hrs each time• Preventive medications were tried and ineffective• No contraindication
The injections• 31 small injections • 155-195 Units of BOTOX• Takes 5-10 minutes• Performed in the office
Picture: Allergan
Contraindications• If you are allergic• Neuromuscular diseases such as Myasthenia
Gravis or ALS• Infection at the injection site.
Side Effects• Eyelid drooping• Bleeding• Bruising• Head drop• Weakness• Infection
Side Effects• Muscle weakness• Difficulties swallowing• Difficulties breathing• Double vision and blurry vision• Pain at the injection site.