Friday, July 18, 2008

Deciding Whether to Gamble on Botox for Migraine Prevention


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When I saw the local neurologist a few weeks ago, he strongly suggested I consider receiving Botox injections. I've been thinking hard about whether this is something I want to pursue ever since the appointment.

The injections will be expensive (approximately $1,000 every three months), and my insurance will not cover any portion of the cost.

I'm getting some relief using the Ketamine nasal spray, supplements and herbs and Namenda.

There have been serious questions raised about the safety of Botox injections for purposes other than cosmetic. Cosmetic uses of Botox are generally considered safe because so little of the medication is used in these procedures. But when used for medical applications much more of the medication is injected into the patient, which has led to a variety of complications, including respiratory failure.

The latest study indicating that Botox is effective in preventing migraines was limited to patients who, like me, have not responded to oral preventative therapies. The fact that the group receiving the Botox had greater relief than the group receiving placebo bodes well for the chances it might help me.

Further, the doctor who would be giving me the treatment learned the protocol he uses from the authors of that study, so I know I'd be receiving the same treatment as was part of that study.

However, patients did not obtain the benefit from Botox until six months after receiving the first set of injections. This means I would likely have to commit to receiving at least three sets of injections (every three months) to fully be able to rule out the Botox as a viable option. Doing it just once would not seem to be sufficiently revealing. That's a minimum investment of $3,000 and potentially absolutely no benefit.

And there are other studies calling the efficacy of Botox for migraine prevention into question. Guidelines developed by the American Academy of Neurology and released in May 2008 concluded Botox was no more effective than placebo in preventing migraine attacks and should not be offered to patients with episodic migraine or chronic tension type headaches.

I'm quite honestly completely at a loss at how to reconcile these completely opposite conclusions. I'm disinclined to go for it any time soon. My instincts are telling me no, and I don't feel there is probably much chance it will help.

Sources:
A Few Words of Caution for Botox Users
Botox Shots May Help Ward Off Migraines
Botulinum Toxin Type A as Migraine Preventative Treatment in Patients Previously Failing Oral Prophylactic Treatment

Botox Works on Muscle Disorders But Not Migraines

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