BOTOX & Chronic Migraine
the United States. It is more diffi cult to treat and manage than episodic migraine. Chronic migraine imposes a signifi cant burden on both the individual and society. Chronic migraine is underdiagnosed.
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Data from the American Migraine Preva- lence and Prevention (AMPP) study (Neu- rology 2008;71:559) showed that only 20% of chronic migraineurs obtain an accurate diagnosis. While neurologists (and headache medicine physicians spe- cifi cally) are recognized as the experts for migraine, the AMPP study showed that individuals with chronic migraine had sought evaluation from numerous other types of providers, including chiropractors, allergists, dentists, psychologists, and physical therapists. While some of these providers may be able to assist in some aspects of disability related to chronic migraine, many may be unsuitable for most in comprehensively diagnosing and treating the disease. This may account in
hronic migraine is a subtype of migraine headache and affects ap- proximately 2% of individuals in
part for the low rate of diagnosis of chron- ic migraine in these patients and the fre- quent diagnosis of conditions such as “sinus headaches,” “tension headaches,” “and stress headaches.”
Chronic migraine is undertreated. Likely related to the breadth of provider type as well as other reasons, most patients with chronic migraine do not obtain mi- graine-specifi c treatment. In the AMPP study fewer than one-third of patients obtained migraine-specifi c medications, whether for acute treatment or for disease prevention. Undesirable prescription non- migraine acute pain medications were used frequently, including opioids in 29% and butalbital (e.g. fi oricet and fi orinal) in 15%.
The impact of chronic migraine on
individuals is signifi cantly greater com- pared to those with episodic migraine. Assessing patient disability using the Mi- graine Disability Assessment (MIDAS) questionnaire revealed that approximate- ly 8% of those with chronic migraine missed at least 5 days of work or school over a three-month period of time; more
than 50% missed at least 5 days of house- hold work over the same period. It is estimated that migraine disorders cost society $16 billion dollars per year in lost wages, worker productivity, and ex- penses related to medications, doctor visits, and emergency room visits. Most simply, chronic migraine is a
disorder characterized by more headache days than not. The headaches typically last at least four hours in duration when not treated with medication. The high head- ache frequency is present for at least three months. Many of the headaches should have migraine elements when untreated, such as one-sided throbbing pain, with nausea or vomiting, and associated with sensitivities to lights, sounds, or move- ments.
Ideally an individual will track their
MARSHALL C. FREEMAN, MD Specializing in the diagnosis
and management of complicated
headaches. We are dedicated to helping patients treat their headaches and return to normal activities.
BOTOX • Clinical Trials
1414 Yanceyville Street • Greensboro, NC 27405 336.574.8000
40
www.HeadacheWellnessCenter.com NaturalTriad.com
headache days accurately using a head- ache calendar. For those new patients who are uncertain of their exact headache frequency, I will ask how many com- pletely pain-free days they experience, since this is often an easier number to remember. Most patients underestimate their headache numbers, but pain-free days are more accurately recalled. A cor- rect diagnosis of chronic migraine does not require that every headache is severe or disabling: the core feature is high fre- quency headaches.
BOTOX BOTOX (onabotulinumtoxinA) is one
type of migraine preventive agent. This is the same BOTOX that is used for cos- metic purposes, as well as for other neu- rological, urological, and ophthalmologi- cal conditions. BOTOX is an FDA-ap- proved injectable product that is adminis- tered in a physician’s offi ce for chronic
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