First, Lets know a little about Migraine
Migraine is one of the common neurological disorders complaining of pulsating unilateral or bilateral headache. It ranked as the seventh most disabling disease amongst all diseases worldwide. The features observed are recurrent attacks of headache lasts for 4-72 hours with moderate or severe intensity and aggravation by routine physical activity. Migraine attacks followed with nausea, vomiting, photophobia and phonophobia. The prevalence of migraine attacks is being observed globally and based on population study it accounts around 15% of the population. The noticeable point considering the age factor is that we find it in both men and women from adolescence to midlife but declines after the fifth decade of life.
Classification of Migraine
Usually migraine is distinctly into two types of viz. Migraine without aura and migraine with aura. According to the clinicians, they distinguish migraine as episodic migraine (EM) and chronic migraine (CM). EM is more common and refers to the patients with patients, who suffer from migraine attacks, but miss the criteria for CM. Whereas, they describe CM as a migraine headache present on at least 15 days per month for over 3 months. Also, CM cases are prone to the wide range of comorbid conditions such as asthma, chronic obstructive pulmonary disease, obesity, heart disease, stroke, depression and anxiety.
Baseline treatment regimen against Migraine Attacks
The two basic strategies adopted to treat the migraine patients are abortive treatment of acute migraine attacks and prophylactic treatment, or it is also a placebo. Frequently used pharmacological substances for the abortion of migraine attacks are nonsteroidal anti-inflammatory drugs (NSAIDs) and triptanes. These treatment regimens are effective to an extent but the usage of both i.e. NSAIDs and triptanes may lead to medication overuse headaches. Therefore, there is a need for an alternative to overcome adverse effects of the existing drugs.
What is Botulinum Toxin?
Botulinum toxin (BoTN) is a toxin produced by the bacteria Clostridium botulinum (Gram-positive, anaerobic, spore-forming bacteria). The produced toxin is a protein complex. Basically, the bacteria cause botulism, because of the intake of spoiled food. There are seven different BoTN serotypes, among them BoTN A and BoTN B are of clinical importance. Usually, BoTN A is used to treat the migraine attacks as Botox shots.
The already known fact about BoTN, is the usage of shots of Botox which helps to provide smooth wrinkles because it relaxes muscles in the face. Besides this, it also reliefs people myorelaxant. Several proved that the effect of OnabotulinumtoxinA (Botox) is not only limited to prophylactic treatment, rather its improved quality of life in CM patients. In maximum CM cases it showed positive results in the form of a reduction of monthly headache days and along with few adverse effects like neck pain, injection site pain, eyelid ptosis, muscular weakness. Allergic reactions include shortness of breath, or swelling in your lower legs.
How Botulinum Toxin Works?
It bases the mode of action on injecting the toxin intramuscularly or subcutaneously, which enters peripheral motor neurons. This as result binds to the target protein and blocks chemicals called neurotransmitters and is responsible for pain signals and inhibits activation of pain networks in the brain. The mechanism of action leads to the relief of pain.
Who can have these Botox Injections?
The National Institute for Health and Care Excellence (NICE) issued guidance in June 2012 recommending Botox is available on the NHS as a preventive treatment option for adult patients with chronic migraine. FDA has approved the usage of Botox injections against the migraine attacks, but only for the management of chronic migraine patients. Botox injections are limited to a few specialists at headache centers.
