Migraines occur in 10% of the population and can vary from the occasional throbbing headache to debilitating chronic pain for most of the month. They can be accompanied by nausea, light sensitivity and warning symptoms known as aura. Appropriate management is stepwise and starts with avoiding triggers such as foods (cheese, chocolate, red wine) stress and medications such as the Pill or HRT. Medical treatments are divided into pain relieving medications during an acute attack and preventative medicines.
However the option of Botulinum injections has been shown to be effective in chronic migraine. In the mid-1990s a number of patients reported an improvement in headaches after receiving botulinum toxin for other reasons. The PREEMPT trial found that receiving Botox® every 12 weeks showed significant benefit in patients suffering from chronic migraine. After 6 months patients had an average of 8 fewer days of headache a month. After 12 months 70% of those treated had less than half the number of headaches per month than beforehand. Injections are given to the head and neck (a wider area than for most cosmetic treatments). Interestingly we are not sure exactly how the treatment improves symptoms. However a recent study suggests that the toxin reduces the expression of certain pain pathways rather than working via muscle relaxation.
It is important to emphasise that patients have an accurate diagnosis. It can be useful to keep a headache diary before attending a health professional. In some cases further investigation is required and it is best to discuss this with your doctor.