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USE OF BOTULINUM TOXIN FOR MIGRAINE-TENSION HEADACHES
Botox injections have been shown to reduce the frequency and maximal severity of migraine headaches, as well as migraine-associated vomiting and the number of days acute migraine medication is needed. The mechanism of action of botulinum toxin in relieving headache is not fully understood. Most Investigators believe that it’s the toxin’s ability to decrease muscle tone by inhibiting the release of acetylcholine at the neuromuscular junction. in addition, there is growing evidence that it also inhibits exocytosis of other neurotransmitters and neurally active substances. Botox is FDA approved for treatment of migraine headaches and is covered by most PPO insurances.
TYPES OF HEADACHES
Vascular Headaches-Migraine Type These types of headaches are described as recurrent and vary in intensity, frequency, and duration. They are a worldwide prevalence of between 8% and 18% and are responsible for $1 billion in medical costs and $16 billion in lost productivity per year in the United States alone. Migraine is a French word that means one-sided headache. The classic migraine is a vascular headache that is preceded by an “aura”. An “aura” is a transient visual or motor prodrome. The attacks are commonly unilateral and associated with anorexia, nausea, and vomiting. Migraines are more common in the female population and there is usually a familial history.
Migraine headaches are usually brought about by a variety of stressful situations. Other triggering factors include change in hormonal levels as in menstruating females or changes in blood sugar as in hypoglycemia. Certain foods such as alcohol, chocolate, nuts, or aged cheese can precipitate an attack. Physical stimuli such as a stuffy room or bright lights can also be triggers. The typical migraine personality is compulsive, ambitious, and has an emphasis on perfection.
Medication used for migraine headaches include nonsteroidal anti-inflammatory drugs, Ergotamine, Methysergide, Lithium, Beta-Blockers, Tricyclic Antidepressants, muscle relaxants, and calcium channel-blockers. Biofeedback and relaxation therapy has also been helpful.
Muscle-Tension Contraction Headaches This type of headache is usually described as a nonpulsatile, tightness in the suboccipital regions bilaterally. It is commonly caused by sustained contraction of the skeletal musculature. This headache is related to both physical and emotional stress, and is typically worse in the afternoon. Treatment for this type of headache includes muscle relaxants, antidepressants, beta blockers, and nerve block procedures.
Mixed (Combined) Headaches This type of headache exists when both vascular and muscular symptoms co-exist. Typically is a constant bilateral or unilateral headache of severe intensity, lasting for 2-3 days. This type of headache has both physical and emotional elements of a migraine and muscular headache. Treatment is the same as for both prior types of headaches.