Australian chronic migraine sufferers, who have just about given up hope, after trying at least three preventive medications, may have reason to have a spring in their step… the Pharmaceutical Benefits Scheme (PBS) has started funding Botox injections to prevent chronic migraines.
What are headaches?
(Lucky you, if you have to ask!)
Headaches are quite literally, an ache (sore sensation) in the head. They are often a symptom of a pathological systemic process, such as dehydration, fasting, illness, stress or medication side effects. Most people will get a headache from time to time, with mild to moderate discomfort.
Botox, which has various cosmetic and medicinal uses (Good-bye wrinkles!), is subsidised for adults who suffer headaches for at least 15 days a month.
Types of headache include:
- Common headache
- Tension headache
- Rebound headache
- Drug related headache
- Coital headache (a rare type of severe headache that occurs at the base of the skull before orgasm during sexual activity)
- Food reaction headache
Rarely a headache is an indication of something more serious including haemorrhagic stroke, infection, hypertension (high blood pressure) and tumour. If you are experiencing a sudden onset of the “worst headache” of your life, consult immediate emergency medical attention.
How the brain experiences pain
The brain is a complex network of nerves, which transmit messages throughout the body. The symptoms of both headaches and migraines may feel like the brain is in pain, however; the brain itself does not experience sensation. The membrane of and vessels in the brain, and pain sensitive structures (neck, face, sinus, eyes, and ears) near the brain have a network of sensory nerves. The brain expresses the messages of pain from these neighbouring structures as a headache. This shows us why headaches are so common and causes so varied.
What are migraines?
Migraines are less common than common headaches. Around 20% of the population have experienced a migraine. Predisposition to migraines include female gender, under the age of 40 and family history. It is said that migraines are more common in people with high stress lifestyles or low mood, however; these two factors may not show true cause-and-effect.
Chronic illness (such as chronic headaches or migraines) is known to cause low mood and increased lifestyle stress. The World Health Organisation research concluded that a chronic headache has a greater impact on functioning than other neurological diseases. Furthermore, the WHO highlighted that the impact of migraines is upon not only individuals, but also workplaces and the economy. 36% of migraine suffers reported taking at least 2 sick days a month because of migraines. A proportion of this group were unable to work full-time.
Unlike tension headaches, which are localised to the forehead region, pain associated with migraines is located to one side of the head. The pain is described as throbbing and unbearable, and can be made worse by movement. Individuals may also suffer from in the lead up to, during or after a migraine:
- Light sensitivity
- Sound sensitivity
- Smell sensitivity
- Neck and shoulder pain
- Physical weakness
- General malaise
- Visual disturbances called auras before the migraine begins.
It is helpful to manage your migraines with a health professional. Keep a diary of symptoms to help diagnose your migraines accurately and keep note any triggers such a medications, alcohol, illness and stress.
Traditionally, migraine treatment consists of a range of medications that are preventative and acute responses. Analgesia is an accessible and first line response to migraines, which can be managed by the individual at home and in consultation with a pharmacist. Usual analgesia includes paracetamol, codeine and non-steroidal anti-inflammatory drugs. Each analgesic migraine treatment has benefits, and many people may choose a combination of medicines to reduce the severity of symptoms of migraines.
Migraines may be accompanied by nausea and vomiting, making oral medication difficult to take without anti-emetic medication (or using a different administration route such as suppository). Anti-emetics are drugs that reduce the feelings of nausea and incidence of vomiting. Anti-emetic migraine treatments are available through pharmacies or on a prescription.
Natural migraine treatments are often used complimentary to usual migraine treatments. Using lavender and peppermint oil as a temple massage or on an oil burner is thought to reduce painful migraine symptoms, and drinking ginger tea to calm nausea and vomiting. As always with any medication, check that your choice of complimentary medicines are not contraindicated.
If migraines are significantly affecting quality of life and usual treatment is not successful, there are other types of medication that have been identified as useful in migraine treatment. These are identified as anti-epileptics (works on the nerves), anti-depressants (works on brain chemicals called neurotransmitters), beta blockers (blood pressure tablets) and muscle relaxants.
Muscle relaxant injections as a ‘muscle relaxant’ migraine treatment in Australia is relatively new. Traditional muscle relaxants such as benzodiazepines are addictive, have diminishing returns (you need more and more of the drug to get the same effect) and are an acute treatment, rather than preventative. Botox migraine treatment consists of injections into 7 muscle groups of the neck and head, two of the areas associated with headaches. A specially trained neurologist gives patients injections into their head and neck every 12 weeks. Up to 155 units are used across the corrugators (near the inner eyes), procerus (between the eyebrows), frontalis (forehead), temporalis (temples), occipital (back of the head), cervical paraspinal (top of neck) and trapezius (base of the neck).
These are given with a fine needle in 31 spots, including the forehead, temples and back of the head, says Melbourne neurologist Dr Richard Stark (who just happens to be the father of my Melbourne neurologist!).