Migraine is a well-known disorder in our society. Migraine can be debilitating, and it is responsible for billions of dollars annually in lost wages and time off work.
Typical migraine headaches are frequently unilateral (but can occur bilaterally) and are pulsating in nature. Symptoms include, but are not limited to, nausea, vomiting and increased sensitivity to light and sound. Symptoms typically worsen with physical activity. Approximately one-third of people who suffer from migraine headaches perceive aura (an unusual visual, olfactory, or other sensory experiences that are a sign that migraine will soon occur).
Episodic migraine is defined as headaches occurring on 14 or fewer days per month. Conversely, chronic migraine is defined as those with persistent migraine headache (and related symptoms) occurring > 15 days per month with headache lasting 4 hours a day or longer. The burden of disease associated with chronic migraine has a huge impact on society. Chronic migraineurs have 2.8-fold higher acute prescription medication costs than episodic migraineurs, and they are significantly more likely than episodic migraineurs to visit the emergency room, their primary care physician, a neurologist, or a headache specialist. Furthermore, direct and indirect healthcare costs are 341% higher per patient for chronic migraineurs than for episodic migraineurs.
Initial treatment is with analgesics (e.g. Ibuprofen, Aspirin or Tylenol) for the headache, an antiemetic (e.g. Phenergan or Zofran) for the nausea, and avoidance of triggering conditions. Triggers will vary from person-to-person and can include, but are not limited to, physical exertion, stress, neck pain, sleep disturbance, lights, alcohol, smoke, hormonal changes, and certain foods and smells. There are medications to help abort or lessen the effects of migraine once they occur (e.g. triptans and ergotamines) and several classes of medicines are typically prescribed for prophylaxis treatment in patients with frequent recurrence of migraine (beta blockers, calcium channel blockers, anticonvulsants and tricyclic antidepressants).
An emerging and effective treatment for chronic migraine is BOTOX. The results of two large randomized, double-blinded, placebo-controlled studies show significant benefit in patients with chronic migraine.1, 2 The combined results of the studies showed that treatment with BOTOX resulted in significant reductions in the number of headache days, cumulative hours of headache on headache days, and decreased frequency of moderate-to-severe headache days. Very little treatment related adverse affects were reported.
1 Aurora SK, Dodick DW, Turkel CC, et al. OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalgia 2010 Jul;30(7):793-803.
2 Diener HC, Dodick DW, Aurora SK, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia. 2010 Jul;30(7):804-14.