Migraine is a neurological condition characterized by recurrent headache attacks. The official definition of chronic migraine is having headaches 15 days/month for at least 3 months. Also, on 8 or more days every month, the headaches should have some typical features of migraine, such as throbbing pain, sensitivity to light and sound, or nausea. Other causes of headaches should be ruled out before diagnosing chronic migraine.
Migraine attacks usually last 4 to 72 hours and are typically marked by a pulsating quality, unilateral location, moderate to severe intensity, and worsening with routine physical activity.
Some common symptoms of chronic migraine include:
Treatment Options
Acute treatment with anti-inflammatory medications, paracetamol, triptans and antinausea medications, which works better if taken early in the course of the episode and repeated until symptoms resolve.
Non- pharmacological measures and several medications are used to prevent migraines (prophylaxis). A healthy lifestyle is important in management, including a healthy diet, avoiding obesity, exercise, adequate hydration and a sleep routine.
One way to treat chronic migraine is to inject botulinum toxin, which blocks nerve signals into your head and neck muscles. Scientists don’t know how botulinum toxin works for chronic migraines, but they think it stops some brain chemicals that cause migraine pain.
Botulinum toxin may lower the activity of the nerves that carry pain signals from your head to your brain. It may also help relax your muscles and reduce the pressure points that trigger migraines.
The TGA (Therapeutic Goods Administration) approved botulinum toxin for chronic migraine in 2011. Research shows that botulinum toxin is safe and effective for many people with chronic migraine who don’t get better with other treatments.
Patients with chronic migraine who have failed to respond to three oral preventative medications or experienced intolerable side effects are eligible for botulinum toxin A (Botox) treatment.
The neurotoxin is administered by a neurologist per the PREEMPT protocol, which involves 31 injections into seven specific muscle groups in the head and neck region every three months.
The Pharmaceutical Benefits Scheme (PBS) criteria require that patients have at least 15 headache days per month, of which at least eight are migraine days, and that they have completed a headache diary to confirm their diagnosis and monitor their response to treatment.
A trained neurologist gives injections into specific areas of the head and neck muscles every 12 weeks. Some non-serious adverse events may occur, such as pain, swelling, bruising, headache, or drooping eyelids.
Botulinum toxin (Botox) injections for chronic migraine can help decrease the frequency and severity of migraine by about two days per month compared with placebo treatment. However, they are not a quick fix and may take four weeks or more to show results.
