Migraine and botulinum toxin
Botulinum toxin type A (Botox) is used to prevent headaches in patients with chronic migraine who suffer from headaches at least 15 days per month of which at least 8 days are with migraine. This is a very effective therapy that has been proven in the highest class of clinical trials.
more:
https://www.ncbi.nlm.nih.gov/pubmed/25431141
https://www.ncbi.nlm.nih.gov/pubmed/25399521
https://www.ncbi.nlm.nih.gov/pubmed/20487038
It is also a drug that has a high safety profile and for decades botulinum toxin type A (Botox) has been used in the Czech Republic in a number of indications in neurology, physiotherapy, urology, surgery and cosmetics. For example in neurology, which is the most important area, we use this drug in patients with spasticity after a stroke, patients with cervical dystonia, blepharospasm, facial hemispasmem, another focal dystonia, and also for example for over 20 years in children with cerebral palsy. More >>>
Application of botulinum toxin in patients with migraine is carried out approximately once every three months we use very thin needles and usually administer from 155 to 195 units of Botox. There are 5 units in one injection and thus we apply generally from 31 to 39 sites in the forehead, temples, headers, back of the neck and the area of trapezoid muscles.
Places most often applied in patients with migraine.
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Before the first application the physician examines carefully the patient and his/her case history (anamnesis) and if botulinum toxin is medically indicated the physician notifies the patient about the procedure – how this therapy works and what the possible side effects are. The consultation mentioned above often involves a separate visit to the physician and lasts approximately from 30 to 60 minutes. Subsequently, if the patient agrees to the treatment he/she signs the informed consent and botulinum toxin may be applied. A clinical visit with botulinum toxin application lasts for approximately 30 minutes or longer. The effect of botulinum toxin starts after about 7 days and the other check visit is performed approximately 1 month after the injection/s. At that time we expect the maximum effect of botulinum toxin. If the botulinum toxin is efficient it could be applied repeatedly once every three months at the most or less frequently with no limit to the number of future applications.
The important information necessary to know is mentioned below:
What to expect after the application of botulinum toxin:
The effect of botulinum toxin should appear on average 7 days after injection. Maximum effect, which means the time when botulinum toxin´s effect should arise with full strength, is approximately one month after injection and its overall duration is about 3 months. There is an inter-individual variability in the botulinum toxin effect’s duration. This means the effect’s onset could vary from 3 to 10 days after the injection and its duration might differ from 2 to 6 months. It also depends on the number of units applied, which means the more units the stronger the expected effect. Conversely, if the patient is ill (e.g. a cold, flu or other acute illness) at the time of application the botulinum toxin therapy could completely fail and there is even the risk of future inefficiency. If botulinum toxin is properly indicated the majority of patients respond to the therapy very well. Patients satisfied with the treatment usually come for application approximately from 2 to 4 times per year. If the first application does not work it is strongly recommended to try one more treatment session. For long-term treatment to be indicated the medication must represent a clear benefit for the patient in the therapy of migraine.
Who may administer botulinum toxin:
It is advisable that the physician who uses botulinum toxin has long-term experience with its application. It is a very specific drug that requires a highly professional approach and thorough knowledge of both application schemas and the side effects. The physician who applies botulinum toxin at our department has worked with this medication for over 10 years in the treatment of various diseases.
Questionnaires:
We use questionnaires to monitor the gravity of a patient’s headache. The first one should be filled in regularly every day, the second immediately before application and the third one month after the application of botulinum toxin. Questionnaires help the physician to understand the patient’s problem.
Informed consent:
The patient will have signed informed consent before the first application of botulinum toxin. It is not mandatory in the health care system of the Czech Republic, however, in our department it is assurance that you have been thoroughly instructed about the medication and that we didn’t omit any relevant information. Informed consent contains some basic information on botulinum toxin treatment and is focused also on its side effects. An original of the informed consent remains in our medical documentation and there is a copy is for the patient.
Side effects of botulinum toxin:
It is well known that all drugs can have side effects (adverse events). The physician who administers the drug must be sure that this drug has a greater benefit (positive impact / importance) to the patient than its probable side effects. Side effects are listed in the leaflet which is compulsory for each drug distributed in the Czech Republic. For Botox you can download this information from the website of the SÚKL (Státní ústav pro kontrolu léčiv = State Institute for Drug Control) database. At the same time we have the side effects of botulinum toxin listed in our Informed Consent here (information in English).
How I can get to the application of botulinum toxin:
The ideal situation is if you have been monitored for migraine by your neurologist for a long time and meet the indication criteria for the application. The criteria are: headaches at least 15 days per month, of which a minimum 8 days with migraines. In this case and on condition that you are interested in botulinum toxin treatment, please contact us. You are also recommended, of course, to consult your neurologist. Anyway, it is vital to let your neurologist know about the botulinum toxin application. If botulinum toxin significantly alleviates your headaches, the reduction of long-term peroral medication logically follows which will influence positively both your health and the quality of your life. If you are unsure of the botulinum toxin therapy, you can join us also, or you can contact us via email. (Email: neuro.km@gmail.com, Telephone number: 00 420 730 415 109)
How the botulinum toxin applications are covered:
Currently, applications of botulinum toxin are not covered by health insurance and are fully paid by the patient. The recommended dose for migraine is 155-195 units and costs 9800 CZK. In the case of treatment with a lower dose 6200 CZK. For further information, please contact us by e-mail or telephone.
If you are interested, please contact us, preferably by email: neurologiezidlochovice@seznam.cz
Please include “Dr. Eduard Minks” in the subject line of the email.
Telephone number: 00 420 730 415 109
Eduard Minks, MD, Ph.D.