Chronic Migraine Where Other Treatments Have Failed

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:

• Headaches that are either moderately painful to extremely debilitating
• Aching on one side of the head, or both
• A pulsating, throbbing sensation
• Sensitivity to light, sound, and odours
• Nausea, vomiting, or both
• Aura (visual disturbances such as flashes of light or blind spots)
• Dizziness
• Tingling and numbness

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.

• Medications such as beta-blockers, antidepressants, muscle relaxants and anticonvulsants and others are used in the treatment.
• Botox Injection
• CGRP inhibitor
• Nerve stimulators, e.g. Cefaly device

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.