Botox Injections Have Benefit for Chronic Headaches

A new review and analysis of previous studies has found that botulinum toxin A (“Botox”) injections have a small to modest benefit for those with chronic migraine headaches and chronic daily headache. Botulinum toxin A injections were first proposed as headache treatment when it was observed that patients with chronic headaches receiving cosmetic botulinum injections experienced headache improvement, prompting several case series that suggested benefit. Jeffrey L. Jackson, M.D., M.P.H., of the Medical College of Wisconsin, Milwaukee, and colleagues performed a review and meta-analysis to assess the association of botulinum toxin A with reducing headache frequency when used for preventive treatment of migraine, tension, or chronic daily headaches in adults. In the study, headaches were categorized as episodic (less than 15 headaches per month) or chronic (15 or more headaches per month) migraine and episodic or chronic daily or tension … Read more

Cluster Headache Features and Therapeutic Options

A review article titled “Cluster Headache: Clinical Features and Therapeutic Options” written by Charly Gaul, Hans-Christoph Diener, and Oliver M. Muller published in Deutsches Ärzteblatt International (vol. 108, issue 33, pages 543-549, 2011) provides an interesting look on new options for those with a chronic refractory cluster headache. The article discusses how 120,000 people in Germany are affected by cluster headache. The attacks are in the periorbital area on one side and last 90 minutes on average. The attacks often posses a circadian and seasonal rhythm. The author lists the diagnostic criteria for cluster headache as from the International Classification of Headache Disorders (ICHD-II). First line drugs for treatment include verapamil and cortisione or lithium and topirmate. In addition, short term relief can be obtained by local anesthetics and steroids along the course of the greater occipital nerve. I have … Read more

Headaches after Traumatic Brain Injury Highest in Adolescents and Girls

A recent study has been conducted by the Seattle Children’s Research Institute and appeared in Pediatrics, vol 129, number 1, January 2012, pages 1 to 9, titled Headache After Pediatric Traumatic Brain Injury: A Cohort Study, wirtten by Heidi K. Blume and et al. The article discusses how in the adult population 18% to 33% of those who suffer from traumatic brain injury suffer from headaches 1 year after the injury. In the child population most of the investigations conducted have been small, retrospective, lacked a control, or involved only short term follow up. Chronic headaches with children are associated with interference in social function, parental productivity, and poor quality of life. The study randomly selected 1507 patients with TBI and 495 controls with arm injury (AI) for the study. However, some patients were not reachable, others were inegligible, and … Read more

Behavioral Treatment for Migraine Headaches

A recently study titled Direct Costs of Preventive Headache Treatments: Comparison of Behavioral and Pharmacologic Approaches appearing in Headache: The Journal of Head and Face Pain, 51 (6): 985 -991, June 2011, and written by Allison M. Shafer et al., finds that treating chronic migraines using inexpensive prophylactic medicines such as beta-blockers or tricyclic antidepressants and behavioral approaches such as relaxation training, biofeedback, cognitive behavioral therapy, and stress management are a low cost and effective treatment option particularly after 1 year of treatment. The authors used a cost minimization analysis and found that after 1 year, the cost of minimal-contact behavioral treatment was cheaper than the least expensive headache treatment medications. Minimal-contact or home based intervention is when a patient sees a therapist for around 3 or 4 visits and  largely practices the behavioral techniques at home through the use of … Read more

Surgical Treatment of Migraine Headaches

A study published in Plastic and Reconstructive Surgery shows that trigger site surgery may aid in reducing or even eliminating migraine headaches. 100 patients in a study underwent injection of botulinum toxin A (Botox) into up to 4 potential trigger sites. If a trigger site was identified to be effective than surgery was performed in that trigger area in order to decompress nerves and remove muscles. 71 of 79 patients that were evaluated over a 5 year period were observed to have improvement. This meant they had less mean migraine intensity and or less mean migraine duration. 20 of 69 patients (29.0%) reported elimination of migraines and 41 of 69 patients (59.4%) experience a significant decrease. Surgery is not without risk and neither is injection of botulinum toxin A.  2 patients had hypersensitivity, 2 patients had hyposensitivity, and 2 patients … Read more