There are over 38 million Americans suffering with migraines. A surprising one in four households has a migraine sufferer, with women three times more likely to suffer from migraines than men. Migraines are much more than a headache, with symptoms including nausea; vomiting; sensitivity to light, smells and sound; dizziness; visual disturbances; tunnel vision; blind spots; pins and needles in limbs; and vertigo. For those sufferers it can be debilitating and life altering. Up until recently, solutions and successful treatments have been elusive.
For Deirdre Kamber Todd of Allentown, dealing with debilitating migraines has been a lifelong challenge. Her first experience of a migraine episode happened at the early age of six years old, with episodes increasing in frequency as she got older, and they intensified during college and law school. “I was very athletic, involved in a lot of clubs and social, but I was forced to spend days at a time in a dark room in bed, making it very difficult to keep up with my classes, commitments and normal friendships,” she says. Todd went through a battery of tests with specialists and was prescribed a host of medications whose side effects were often worse than the migraines themselves. Over the years, Todd worked hard to manage the symptoms and triggers, and symptoms moderated in her 30s. She utilized meditation, exercise and avoided certain foods, lighting and smells as best she could to manage and minimize the onset of the migraines.
Living with Migraines
Todd was coping until she got into her 40s and the incapacitating migraines were back with a vengeance. This is often the case, as there seems to be a strong link between hormonal shifts and migraine intensity and frequency. A busy mom with a busy law practice, Todd recalls, “I felt normal about five days out of the month.” She describes the migraines as a total system collapse. Headaches were the least of her worries—the nausea, vomiting, stomach issues, nasal issues and visual disturbances would all force her to shut down.
“I couldn't stop the migraine episodes, but I learned how to hold them at bay until the weekends, and then I would crash,” she says. As such, it meant always making choices of what she could and couldn't do to try and keep her migraines under control. It affected her family time, her relationships and changed how she lived her life.
Unfortunately, the causes of migraines are not fully understood and current pharmacological treatments include antidepressants, anti-seizure medications and medications for hypertension, all of which have serious side effects including bone and liver problems—just to name a few.
Botox Treatment
A self-proclaimed “full-blown cynic,” Todd was skeptical when she first heard about Botox as a treatment for migraines. However, careful research led her to Asare Christian, MD, MPH at Good Shepherd Rehabilitation Network.
Dr. Christian explains that headaches and migraines are quite different, but with both, he takes a multidimensional approach starting with a very thorough evaluation. “Everyone is unique, but understanding that 80 percent of health issues are due to lifestyle choices, we explore every contributing factor first,” says Dr. Christian. Stress, dehydration, sugars, food intolerances, smells, environment and sleep cycles all contribute to one's health and can be a trigger for both tension headaches and migraines. Dr. Christian says, “There could be things like tight neck muscles, dystonia in the back, arthritis, occipital neuralgia and medications themselves that could be contributing factors.”
There are strict standards that must be met in order to qualify for Botox treatment. The first and foremost is that you have migraines 15 or more days out of the month, headache episodes lasting more than four hours and have failed medical therapy. The treatment itself involves 31 injections of the neurotoxin botulinum type A to superficial muscles of the head and neck area, which takes only about 15 minutes. The toxin temporarily stops nerve impulses to the muscles and the treatment lasts for 12 weeks, so it must be repeated every 12 weeks. “It was a game changer for me,” says Todd. “I have a better relationship with my husband and children, as we can have fun and explore without the fear of an ensuing episode.” Dr. Christian has seen positive responses in his patients without the long term and serious side effects of the pharmacological options.
The Migraine Spectrum
Lisa Bunin, MD, who has been at the forefront of work and research with Botox since 1989, explains that there is a huge spectrum of migraines. “Migraines are a diagnosis of exclusion,” she says, adding that addressing anything having to do with the head, from tension headaches to migraines, should include a complete eye exam with an ophthalmologist to rule out other possible health issues. Conditions like pigmentary glaucoma, angle closure glaucoma, temporal arteritis and brain tumors are just a few very serious conditions that can give migraine symptoms. “The eye is the only place you can see blood vessels in their natural state. Because of this, as ophthalmologists, we have a unique ability to be able to see autoimmune disease, diabetes, atherosclerosis, vascular diseases—to name a few.” Dr. Bunin also stresses that Botox injections, while becoming much more commonplace, still have inherent risks as it is a neurotoxin, and, therefore, it is critical to see a highly trained and skilled doctor if choosing that route.
While Botox injections were a game changer for Todd, it should be noted that keeping healthy lifestyle practices including diet, exercise and meditation continues to be a part of her health plan. Todd knew that she had to be an active participant in her own health. Getting a thorough examination from your doctor, neurologist and ophthalmologist is critical to rule out other health concerns. Dr. Christian also emphasizes that addressing the basics of good health practices is always first and foremost with any condition. Working on a healthy anti-inflammatory diet, quality sleep, good hydration, stress reduction and exercise may seem simple, but, often, doing the simple things consistently has the biggest rewards.
