Treatment Options for Migraine

What Is a Migraine?

A migraine is a type of headache with distinctive characteristics. It usually causes throbbing pain on one side of the head, although both sides may be affected. The pain commonly occurs around the temples, eye sockets, or back of the head.

Other symptoms may include:

๐ Nausea

๐ Vomiting

๐ Sensitivity to light and sound

๐ Aura, such as flashing lights or visual disturbances

Migraine can be triggered by several factors, including stress, insufficient sleep, hormonal changes, hot weather, and certain foods.

Severity and Stages of Migraine

Migraine pain is usually moderate to severe and may be divided into four stages.

1. Prodrome

Symptoms may occur before the headache begins, such as mood changes or tightness and discomfort in the neck.

2. Aura

Some patients experience neurological warning symptoms, such as flashing lights or unusual visual changes.

3. Headache

This stage commonly causes throbbing pain and may be accompanied by nausea and vomiting.

4. Postdrome

After the headache improves, the patient may feel tired, weak, or lacking in energy.

1. Botulinum Toxin Injections for Chronic Migraine

Clinical studies have found that botulinum toxin injections can help reduce the frequency and severity of chronic migraine.

This treatment is generally recommended for patients who experience headaches on at least 15 days per month.

Botulinum toxin works by reducing the release of substances involved in pain and inflammation, including:

๐ Acetylcholine

๐ Substance P

๐ CGRP

It may also help relax tense muscles around the treated areas.

Patients may begin to notice improvement within approximately 3-5 days after treatment. Botulinum toxin may reduce migraine frequency and severity by around 30-50% in general patients and up to 60-70% in those who respond well.

The effects may last for approximately 12 weeks, or around three months, and treatment can be repeated according to the doctor’s recommendation.

Botulinum Toxin Injection Procedure

Preparation

The doctor will assess the patient’s symptoms, medical history, allergies, current medication, and response to previous treatments to determine whether the treatment is suitable and reduce the risk of side effects.

Injection Areas

The injections are administered at several points around the head and neck, particularly:

๐ Between the eyebrows

๐ Forehead

๐ Back of the head

๐ Neck

๐ Shoulders

These areas are commonly selected to help reduce headache and muscle tension.

Dosage

The total amount may be approximately 100-200 units, depending on the individual patient and the doctor’s assessment.

After the Injection

Patients should:

๐ Avoid pressing, rubbing, or touching the injection areas.

๐ Avoid strenuous exercise for 24 hours after treatment.

๐ Avoid alcohol.

๐ Avoid exposing the treated areas to heat for approximately two weeks.

If unusual symptoms occur, such as worsening headache, swelling, or redness at the injection site, the doctor should be informed immediately.

2. CGRP-Targeted Treatment for Chronic Migraine

CGRP, or Calcitonin Gene-Related Peptide, is a neurotransmitter that plays an important role in migraine pain.

Medicines that target CGRP can help prevent and control migraine attacks by reducing the activity of this pain-related pathway.

How Do CGRP Inhibitors Work?

CGRP inhibitors are a targeted treatment for chronic migraine, particularly for patients who do not respond well to conventional treatments.

The medicine works by either:

๐ Blocking the CGRP receptor

๐ Binding directly to the CGRP molecule

This prevents CGRP from activating its receptor, helping reduce inflammation and pain signalling in the nervous system.

Benefits of CGRP Inhibitors

CGRP inhibitors may help:

๐ Prevent migraine attacks

๐ Reduce the frequency and severity of migraines

๐ Reduce the number of headache days by approximately 4-6 days per month in patients with chronic migraine

๐ Reduce associated symptoms such as nausea and vomiting

๐ Improve quality of life

Possible side effects are usually mild and may include:

๐ Pain at the injection site

๐ Redness

๐ Mild flu-like symptoms

Comparing Botulinum Toxin and CGRP Inhibitors

Botulinum Toxin

๐ Works by reducing the release of pain-related neurotransmitters.

๐ Usually administered every three months.

๐ The reported response rate is approximately 30-50%.

๐ Possible side effects include temporary weakness of the muscles around the injection area.

CGRP Inhibitors

๐ Work by directly blocking CGRP or its receptor.

๐ May be administered once a month or once every three months, depending on the medication.

๐ The reported response rate is approximately 30-70%.

๐ Side effects are generally less common and are usually mild.

Summary

For people with chronic migraine that affects daily life and quality of life, botulinum toxin injections and CGRP inhibitors may be suitable treatment options.

Both treatments can help reduce the frequency and severity of migraine attacks and may reduce the need for frequent pain-relieving medication. The most appropriate treatment should be selected according to the patient’s symptoms, medical history, and the doctor’s assessment.

 

Reference :

Phyathai 1 Hospital How To Treat Migraine

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