• Migraine is the third most common disease in the world
  • Women suffer more than men
  • Botox helps in chronic migraine treatment

Introduction – Migraine is a disabling primary headache disorder characterized with an intense unilateral pounding headache that can last for hours or even days [1]. It is usually an episodic headache associated with sensitivity to light, sound, movement often followed by vomiting[2]. Migraine mostly begins at puberty and it most often affects people between 25-55 years old [3]. The main cause for pain in migraine is probably due to dysfunction of monoaminergic sensory control systems located in the brainstem and thalamus[2]. Brainstem is the posterior part of the brain composed of midbrain, pons and medulla oblongata which controls the flow of signals between brain and the body[4]. Thalamus is a small anatomical structure located above the brainstem, between cerebral cortex and midbrain[5]. Its main function is to relay motor and sensory signals to the cerebral cortex[5].

Fig.1 Migraine Illustration
Image  adopted from [6].

Statistics – It is estimated that migraine is the 3rd most prevalent illness in the world[3]. As an extraordinarily prevalent neurological disease, affects 39 million men, women and children in the U.S. and 1 billion worldwide[3]. Migraine affects three-times as many women as men, due to migraine relations with estrogen levels[7]. Approximately 85% of chronic migraine suffers in the U.S. are women, whereas surprisingly 10% are school-age children, who have had their first attack before the age of 12[3]. In an epidemiological meta-analysis involving 6,216,995 Participants, global migraine prevalence was 10,1% in Asia, 11.4% in Europe, 9.7% in North America, 16,4% in Central and South America which concludes that Central and South American region show a higher prevalence comparing to other regions [8].

Fig.2 Global migraine prevalence changes between regions of Europe, Asia, CSA, and Africa.
Image adopted from [9].

Diagnosing and Medications – There are four different phases of migraines that helps in finding the diagnosis [10]. Prodrome – Most common symptoms of the migraine in this phase include: constipation, food cravings, neck stiffness, or mood changes as well as increased urination [11]. Aura – It may occur before or during migraines, it is characterized by visual disturbances such as: bright spots or flashes, various shapes[10]. In addition to this, there may be muscle weakness, needles sensations in an arm or leg, as well as uncontrollable jerking followed by speaking difficulties [11]. Attack – This phase tends to last from 4 to 72 hours with a frequency that varies from person to person [11]. Symptoms that characterize this face are: unilateral or bilateral pulsing pain of the head, sensitivity to light, sounds or smell and touch, eye pain and lightheadedness [11].Post-drome – known as the final phase occurs after the migraine attack [11].The symptoms vary from person to person; some people may feel drained, pale and tired while some may feel thrilled and overjoyed [11].


Treatment – Treatment of an acute attack of migraine can be achieved by a simple analgesia with aspirin or paracetamol which often can be combined with an antiemetic drug such as metoclopramide or domperdione [12]. If attacks tend to be severe, they can be treated with triptans- a class of drug (e.g sumatriptan, rizatriptan, almotriptan etc), 5-HT agonists that are strong vasoconstrictors of extracranial arteries[12]. They can be administered orally, sublingually by subcutaneous injection or by nasal spray [12]. In any case of frequent attacks occurrence, propranolol or a tricyclic such as amitriptyline or sodium valproate can be used cautiously [12].

Image 3. Areas for Botox Injections
Image adopted from 17.

Latest research – If people tend to have all the symptoms described  at least 15 days per month for more than than 3 months, they are diagnosed with chronic migraine(CM) [13]. Chronic migraine has a huge impact on patients’ lives, therefore keeping the migraine attacks as rare, short and as less harmful as possible in the most efficient way is the main goal in CM treatment [13]. It has been known that Botulinum Toxin type A (Botox) is considered as a great solution specifically for anti-aging purposes [14]. Interestingly, Botox is considered very efficient in reducing the frequency of migraine headaches too [14]. Since, Botulinum neurotoxin injection inhibits the release of acetylcholine release at the neuro muscular junction as well as modifies the release of neurotransmitters which are relevant in transduction of pain such as substance P or calcitonin-gene-related peptide, it is seen very efficient in chronic pain treatment [15]. Data of 17 studies collected from Toulouse University Hospital, Toulouse, France including 3,646 patients given 15 to 20 shots around the head and neck once every three or four months report a tendency in favor of Botox over placebo at 3 months [14]. The findings show a significant reduction in chronic migraine, as well as an improvement of the patient’s quality of life. Botox injections resulted in an average 1,6 fewer attacks per month for chronic sufferers with no severe side effects reported [14],[16].

In conclusion, Botulinum toxin type A is a great solution for chronic migraines treatment, showing a great improvement of patients’ quality of life.

COPYRIGHT: This article is the property of We Speak Science, a non-profit institution co-founded by Dr. Detina Zalli and Dr. Argita Zalli. The article is written by Rexhep Sahatçiu, University of Prishtina, Kosovo.

References:

[1]. The International Classification of Headache Disorders 3rd Edition [2]. Harrison’s Principles of Internal Medicine 18th Edition [3] Migraine research foundation [4]. Medical definition of brainstem https://www.medicinenet.com/script/main/art.asp?articlekey=2517 [5]. News Medical  https://www.news-medical.net/health/What-is-the-Thalamus.aspx  [6]. Alamy- Migraine Illustration https://www.alamy.com/migraine-illustration-image65773864.html [7].  The Migraine Trust
 https://www.migrainetrust.org/about-migraine/migraine-what-is-it/facts-figures/ [8]. Worldwide Migraine epidemiology [9].Research Gate- Global migraine prevalence. https://www.researchgate.net/figure/Global-migraine-prevalence-changes-between-the-years-1930-and-2015-These-results-showed_fig1_301553035 [10]. Medline PLUS- Migraine https://medlineplus.gov/migraine.html [11] .Mayoclinic- Migraine https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201 [12]. Davidson principles and practice of medicine 21 edition.
[13].Botox for Preventinve Anti-Aging https://www.newbeauty.com/hottopic/blogpost/10526-botox-as-anti-aging-treatment/ [14]. Plastic and Reconstructive Surgery- Journal of the American Society of Plastic Surgeons [15].Botulinum toxin in the management of chronic migraine; clinical evidence and experience https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367647/ [16]. The New York Times- Botox may help prevent migraines https://www.nytimes.com/2019/01/08/well/live/botox-may-help-prevent-migraines.html [17].Botox for migraine  https://migrainepal.com/botox-for-migraine/