To Whom Can It Be Applied?
Botulinum toxin treatment for migraine can be applied to chronic migraineurs who spend at least half of the month with headaches and more than half of this pain is in the form of migraine pain. Its effectiveness has not been proven in patients who have a small number of migraine attacks within a month.
Even if they meet the application criteria, it is not recommended for patients under the age of 16.
How is it done?
Migraine-related It is applied to at least 31 points on the forehead, temples, nape, neck and shoulders, where the nerve endings of the brain areas are located, with special injectors with very fine tips. Patients can easily tolerate the slight pain that may occur during the application.
At least 155 units of medicine are used during the application. If the neurologist performing the application deems it appropriate, additional doses can be applied to other areas other than these points. In this case, a maximum of 195 units can be applied.
If performed by an experienced physician, the procedure can be completed in 20 minutes. After the application, the patient can immediately return to work and other daily life activities.
Where Should It Be Done?
Application of botulinum toxin treatment in migraine; It must be performed in a clinical environment, in accordance with hygiene and sterility rules, with the correct technique and in sufficient dosage, by an experienced neurologist. Botulinum toxin application in migraine is never a cosmetic application.
How Often Should It Be Done?
Treatment of migraine with botulinum toxin should be done at least twice with an interval of 3 months.
The physician should decide whether to perform another application after two applications, depending on the patient's condition.
Studies have shown that a large number of patients benefit from the first application, but very few patients do not benefit from the first application. Therefore, it is necessary to apply it at least twice to be able to say whether a migraine patient will benefit from botulinum treatment.
When and How Does Its Effect Appear?
The effect of botulinum toxin begins to appear 10-12 days after application. The frequency and severity of migraine attacks begin to decrease. Pain attacks of patients who spend almost every day with headache occur once a month, sometimes every two months or once a month. It decreases to the frequency of attacks.
What are the Side Effects?
Botulinum toxin treatment in migraine does not cause serious and permanent side effects when done with the right technique and in the right dose. It is difficult to do. However, it should not be forgotten that it may cause side effects such as neck pain, weakness in the neck muscles and drooping eyelids, even if temporary.
How Does Botulinum Toxin Prevent a Migraine Attack?
Muscle The 'inhibiting muscle contraction' effect of botulinum toxin is used in diseases such as dystonia and spasticity that occur due to contractions, and this effect is temporary.
Botulinum toxin is injected into the nerve endings of the brain regions associated with migraine, such as the forehead, temples, nape and neck, and blocks the nerve endings. It penetrates into the brain.
It progresses to the migraine-related areas of the brain through various mechanisms and prevents the release of some neurochemicals (such as CGRP, Substance P) that are released from there and cause migraine headache.
It also prevents the release of some neurochemicals in these nerves. It eliminates sensitization by acting on pain receptors that have become sensitive to pain stimuli.
How Long Does Its Effect Last?
The anti-muscle contraction effect of botulinum toxin lasts for 6 months. It can take up to. For this reason, the applications performed in diseases such as dystonia, spasticity and hemifacial spasm, where we benefit from the muscle relaxant effect of botulinum toxin, may need to be repeated at certain intervals.
However, unlike these medical conditions, the effect of botulinum toxin in migraine does not depend on the muscle relaxant effect! Its direct effect on the nerve cells in the brain regions that cause migraine and the nerve endings of these brain regions reduces the frequency of migraine attacks. Considering the results of the PREEMPT study, which was concluded in 2010, the application can be repeated at certain intervals depending on the patient's condition and the decision of the neurologist who monitors the patient. Thus, patients can be saved from the vicious cycle of chronic migraine. Patients who exit the chronic migraine cycle can maintain their condition with medical measures and lifestyle changes.
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