Botox Against Migraines: Less Expression but Fewer Complaints

Hans Karbay, a neurologist at Tergooi MC, performs about thirty Botox treatments each week for migraine sufferers. “In about a third of patients, results are so positive that they continue treatment. By ‘positive’ I mean completely symptom-free or symptom reduction by 50 percent.”

thirty pricks

During the treatment, Carpay places thirty Botox injections on and around the head and shoulders. “A large dose of botulinum toxin is injected here: about 200 units at a time. This is much more than cosmetic procedures against wrinkles for example. Botox is absorbed into the brain. With the right amount, it has an effect on your brain’s pain systems.”

For Denise van der Boom (37), the Botox treatment is a godsend. “It makes my life more enjoyable. It’s a simple effort and in return I get a relatively high quality of life.”

In the past 15 months, Denise, who was 30 when she was diagnosed with migraines, has undergone five treatments. Do not find the injections annoying or scary. “Every three months I have a new session to make sure the Botox continues to do its job. Some people find it annoying, all those stings in your body. But it doesn’t bother me. I already have a great deal of experience in the medical field. I’ve been through a lot, so the It’s not that bad. It’s a few small, superficial injections and it’s done quickly. Sometimes I have a few little red dots on my forehead after treatment, but thankfully they go away quickly.”

forehead tight

What Dennis finds annoying is that her forehead muscles are a bit stiff. “I have fewer wrinkles and a tighter forehead, but as a result I can frown less. My eyelids are also starting to droop a bit. On top of that, things are really taut and you feel it. As if I’m missing expression. I sometimes think that’s a shame. There are also people who see That this is such a huge disadvantage that they don’t want Botox for this reason.”

To assess whether treatment is successful, a patient must undergo two treatments, Carpay explains. “This takes a total of six months. After the first injection, you have to wait three months for the next treatment, and then it takes another three months before you can determine if the desired results have been achieved.”

Does the treatment work? Then an extension of the periods between treatments may be considered. “It is important that the patient continues to return regularly for Botox injections. If this does not happen, migraine symptoms can return.”

Botox does not act as a muscle relaxant against migraines, but it does have an inhibitory effect on the brain systems that cause pain. According to the neurologist, Botox has few or no side effects compared to other medications. “Besides Botox, there are more treatments that are interfering with your cycle of pain, but Botox has so far been proven to be the treatment with the least side effects. Sometimes other methods have many side effects such as brain inhibition, lethargy, drowsiness, lethargy, and depression.”

Head in a basin of cold water

Unfortunately for Sité (56) – who does not want to use her last name in the article – the side effects were not easy for her. In total, Set was treated for about a year, during which she was injected with botulinum toxin every three months. It was not a pleasant period. “After the injection I felt very tired. The injections hurt, especially the one in my neck. The pain usually lasts about ten days. I felt very warm in my head in the days following the treatment. The only thing that helped me a little bit was hanging my head in a tub of cold water” .

After the first time, the side effects weren’t too bad, but as Sité went through several treatments, they got worse. “At first I thought: It’s annoying, but not as annoying as lying in bed with a headache for ten days. So I continued. But after the 4th treatment it was unbearable. My migraines subsided, but I stopped anyway. I couldn’t stand the side effects anymore.”

CGRP . inhibitors

Sité, who was diagnosed with migraines at age 19 and has double vision during a seizure, is nauseous, confused, anxious and often hard of hearing, is hoping to qualify for so-called CGRP inhibitors. These are medications that are prescribed to prevent migraine attacks, but they are not compensated.

So when Citi visited a headache neurologist’s office last year, she was first introduced to Botox treatment. “I wanted to try the new CGRP inhibitors. To be eligible for compensation, I also had to try Botox. I haven’t had it yet, so I started a process with a neurologist.”

Denise also treated the Botox treatment in this way. “Before I could try CGRP inhibitors, I had to try a botox treatment. I was skeptical at first, but to my surprise, this treatment works so well for me. I’ve had much fewer attacks than before: about four more attacks instead of 10 even 15.” per month. The attacks I have are very severe, but I take them for granted.”

Neurologist and researcher at LUMC Carpay disagree that patients should undergo Botox treatment in order to compensate for the inhibitors. “CGRP inhibitors are an amazing breakthrough in the migraine field and can ensure that attacks are more limited and less severe. I have nothing against Botox, but many patients do not want that. I think you should give people the freedom to choose that. Threshold that lowers the number of People who need CGRP inhibitors can’t get them.”

Nieliki Coles, principal of Hoofdpijnnet, agrees with Carpay. She also supports Botox treatment “as long as people consciously choose it.” “Unfortunately, this is not always the case.”

Compulsory substance for Botox

In order to be compensated for CGRP inhibitors as a migraine patient in the Netherlands, you must meet a number of conditions. “First of all, you must have a chronic migraine. This is the case if you have 15 headache days a month, of which 8 are migraine days. Other treatments must also have failed. Only when you go through this whole process and nothing appears Something to work, did you come for a CGRP-eligible for compensation.”

“This way, nearly a lot of patients have to undergo Botox and it’s not ethical,” Coles says. “The most annoying thing here is that you have to go through the treatment twice to be able to determine if it worked or not. We are talking about 60 injections spread out over six months. This is just nothing. We believe Botox should be your own choice and are working hard to change that “.

What is a migraine?

Migraine is the most common brain disease in the Netherlands. According to LUMC, more than 10 percent of the Dutch population suffers from migraine attacks each year. Migraine attacks can manifest in different ways. In its most common forms, migraines are characterized by:

• Headache attacks last from 4 hours to 3 days

• Severe, throbbing headache on one side that gets worse with exertion

• Side effects such as: nausea, vomiting and sometimes diarrhea

• Sensitivity to light and sound