My doctor has informed me that I have run out of preventatives to try. I know this is not literally true but hearing her say that was rather depressing. I would rather not hear that I have edure this daily torment on a day when I had a particularly nasty migraine. It is true I have tried many preventatives, of all different types and it does not seem to make a difference. But surely she can think of something else, as I know the list is longer than what I have tried. Surely she does not think I have to just suffer and risk losing my job, yet again. She says the only thing left to try is Botox. Well, I don't like the idea of botox injections, they freak me out. Yet apparently this is my only option. And if it fails to reduce the number of migraines then what? She tells me to think about it, or basically wait until I cannot stand it and give in. She says to keep using the Imitrex, but everyone knows you can't use our abortive too many days in a row or you get a rebound. And this is the best doctor I have found. And she is going on the recommendation of my neurlogist, who apparently has also run out of ideas. Perhaps I should write up my own list of possible treatments to help them out.
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Botox Injections last option?
3/ 3/07 1:32pm
I remember 2 doctors saying that to me and they were both wrong, wrong, wrong! I also lost my job due to migraines, and had them daily. However, the abortives worked with me.
I apologize if you have already posted this, but I wonder if you have tried:
1. MigRelief
2. Magnesium
3. Testing your blood for "delayed hypersensitivities" (usually done by a naturopath; MDs don't know about this). You may be eating something healthy (like carrots or onions) and be reacting to them.
4. Beta blockers (like Nadolol)
5. Chiropractic - it significantly decreased my pain.
6. Absolutely refraining from the classic trigger foods, e.g. coffee, chocolate, nuts, etc.
7. Compazine and valium. This is an old method that was used on me in an ER when I was in status migrainosus. Now I have low dose valium and oral/rectal compazine at home if I get a migraine that won't quit. It helps me a lot.
Finally, I would suggest that you get a doctor who specializes in pain, if you haven't already done that. They can be very supportive and help you manage some of the pain "around" migraines, such as what happens postdrome.
Please let us know how you make out. We all "feel your pain" with you and want the best for you.
Sincerely,
Bria
3/ 3/07 2:19pm
I've gotten "the speech" a couple of times from my neurologist. The last one was 2 visits ago. I'm ready to go out of town. On my best day, my daily head pain is a 4. My last really effective preventive stopped working Christmas, 1999.
I've been doing Botox for the last 3 years. It hasn't been my magic bullet, but I did see improvement. I can go every 3 months, and I can tell when it's time for another round. My head gets worse, especially the muscles in my temple and neck.
Botox's effects last only 3 to 6 months. It wears off if you don't like it, and it appears that it has no lasting effects after it is stopped.
My neurologist doesn't do Botox himself. He referred me to an ophthalomologist-plastic surgeon who is specializing in cosmetic procedures. He uses Botox for vanity reasons, in addition to medical reasons. He was on the original team that developed Botox. Its first use was on crossed eyes. The hope was that by paralyzing the "bad" muscles, the "good" muscles would have a chance to grow stronger. That didn't work, but they've found other uses, and Botox still stops the crossed eyes for 3 or 4 months at a time.
The Video of the Week on this site has shown a patient getting Botox treatments. The session showed there is pretty accurate, and my sessions are much the same. I get Botox in the vanity spots every 6 months or so.
My Botox doc has diagnosed me with Spasmodic Torticollis, in which one side of the shoulders/neck pull harder than the other side. In extreme cases, the head is pulled out of line. My Botox injections treat that, too. We do that every 3 months. I get injections in my temples, sometimes in crampy areas of my scalp, in my neck, going into my shoulders and into the upper area of my back.
At first, the doc used an EMG machine while injecting me. A wire is attached to the needle, and a speaker sounds static to reflect the spasming muscle the needle is touching. I can hear the static lessen as the Botox goes in and begins to stop the spasm. We only used EMG for a few sessions. We now know where most of the bothersome areas are.
It's not a painful treatment. The needle is tiny. There are a lot of sticks, but the needle is so thin that there's no pain. The Botox itself doesn't sting, so you really don't feel it going in. I sometimes feel like I have a virus for a few days after a Botox session. It's not severe, and it passes within a week. It's well worth those icky days compared to the relief I get from Botox.
Botox is horribly expensive. My Botox doc doesn't accept insurance. He did for awhile, but then realized that Blue Cross's payments didn't even cover his cost for the Botox. He charges $10 per unit (I think). I have anywhere between 200 and 400 units. As I said, it's expensive, and we're very blessed that we can scare up the money for the treatments.
For some people, Botox is very effective in preventing tension-type headaches and migraine attacks. As I said, I've noticed improvement, especially in the tension-type headaches, but I still have daily pain, and migraine attacks about twice a week.
Gretchen
I've been doing Botox for the last 3 years. It hasn't been my magic bullet, but I did see improvement. I can go every 3 months, and I can tell when it's time for another round. My head gets worse, especially the muscles in my temple and neck.
Botox's effects last only 3 to 6 months. It wears off if you don't like it, and it appears that it has no lasting effects after it is stopped.
My neurologist doesn't do Botox himself. He referred me to an ophthalomologist-plastic surgeon who is specializing in cosmetic procedures. He uses Botox for vanity reasons, in addition to medical reasons. He was on the original team that developed Botox. Its first use was on crossed eyes. The hope was that by paralyzing the "bad" muscles, the "good" muscles would have a chance to grow stronger. That didn't work, but they've found other uses, and Botox still stops the crossed eyes for 3 or 4 months at a time.
The Video of the Week on this site has shown a patient getting Botox treatments. The session showed there is pretty accurate, and my sessions are much the same. I get Botox in the vanity spots every 6 months or so.
My Botox doc has diagnosed me with Spasmodic Torticollis, in which one side of the shoulders/neck pull harder than the other side. In extreme cases, the head is pulled out of line. My Botox injections treat that, too. We do that every 3 months. I get injections in my temples, sometimes in crampy areas of my scalp, in my neck, going into my shoulders and into the upper area of my back.
At first, the doc used an EMG machine while injecting me. A wire is attached to the needle, and a speaker sounds static to reflect the spasming muscle the needle is touching. I can hear the static lessen as the Botox goes in and begins to stop the spasm. We only used EMG for a few sessions. We now know where most of the bothersome areas are.
It's not a painful treatment. The needle is tiny. There are a lot of sticks, but the needle is so thin that there's no pain. The Botox itself doesn't sting, so you really don't feel it going in. I sometimes feel like I have a virus for a few days after a Botox session. It's not severe, and it passes within a week. It's well worth those icky days compared to the relief I get from Botox.
Botox is horribly expensive. My Botox doc doesn't accept insurance. He did for awhile, but then realized that Blue Cross's payments didn't even cover his cost for the Botox. He charges $10 per unit (I think). I have anywhere between 200 and 400 units. As I said, it's expensive, and we're very blessed that we can scare up the money for the treatments.
For some people, Botox is very effective in preventing tension-type headaches and migraine attacks. As I said, I've noticed improvement, especially in the tension-type headaches, but I still have daily pain, and migraine attacks about twice a week.
Gretchen
3/ 3/07 2:54pm
I figured the Botox post was long enough, but I thought I'd chime in on other stuff I've tried and am doing now.
I see a massage therapist once a week. He was recommended by my Botox doc, and this is not a gentle, relaxing massage. Karl finds tender and knotty spots and pinches and squeezes HARD! It's a workout for him, too. He eliminates some of the cramping and spasming. I can tell when I've missed a week.
Consider seeing a physical therapist. I saw one for a couple of years for "myofascial release." They work at the base of your skull, where the muscles are attached. Using pressure, they relax the muscles of the neck. After a session, I can touch my ear to my shoulder and lie down and touch my ear to the mattress. Early on, I went 2 or 3 times a week. I get much the same results from massage. One thing to think about: the PT might be covered by insurance. Massage is not. PT co-pays can be claimed on your tax return. Massage can't.
I took yoga classes for several years. They taught me a lot about my body and gave me control over several things that made my head worse. It's also an hour of focusing on yourself in a gentle, caring atmosphere. My classes were in Iyengar yoga, which concentrates on alignment didn't make me feel threatened or fat.
My dentist makes me a bite guard that I wear at night to keep me from clenching my jaw and grinding my teeth at night. It's a soft plastic that fits over the lower teeth. It's comfortable to wear. I sometimes wear it during the day, when I'm having a clench-y day. It wears out every 6 to 12 months, and they take a new impression and make a new one. It was $125 the last time and was covered by dental insurance.
I think that regular exercise helps, too. It doesn't have to be vigorous, just regular. My dog walks me every morning. I'm not allowed to linger over the funny papers and a second cup of coffee. It's pretty slow going; he has to check on every mailbox. But it gets me outside, in the fresh air and natural light. I get to check out all the neighbors, too. We've switched from 2 miles to only a mile as he's gotten more arthritic -- he's almost 15. I've also got an exercise bike that I ride often.
Have you seen a counselor or psychologist? I saw one for a good while after I had to give up my law practice because of my head. I'd had much of my self-worth tied up in my career, and Anne helped me work through most of that. I also have Major Depression, and I take antidepressants. Some antidepressants can be good preventives, and I think my antidepressants are part of my preventive cocktail.
I've never seen a pain management doctor. My son saw one for a ruptured disk, but he doesn't treat headaches. I've also never done biofeedback. I've seen a chiropractor on 3 different occasions, and while they helped with other problems, they were sure they could *cure* my migraines. They didn't.
As you said, there's always something else. You may have reached your doc's comfort level, and you may be at the point to find a different doc with a different comfort level. But we can't give up. If we do, the migraines have won.
Gretchen
I see a massage therapist once a week. He was recommended by my Botox doc, and this is not a gentle, relaxing massage. Karl finds tender and knotty spots and pinches and squeezes HARD! It's a workout for him, too. He eliminates some of the cramping and spasming. I can tell when I've missed a week.
Consider seeing a physical therapist. I saw one for a couple of years for "myofascial release." They work at the base of your skull, where the muscles are attached. Using pressure, they relax the muscles of the neck. After a session, I can touch my ear to my shoulder and lie down and touch my ear to the mattress. Early on, I went 2 or 3 times a week. I get much the same results from massage. One thing to think about: the PT might be covered by insurance. Massage is not. PT co-pays can be claimed on your tax return. Massage can't.
I took yoga classes for several years. They taught me a lot about my body and gave me control over several things that made my head worse. It's also an hour of focusing on yourself in a gentle, caring atmosphere. My classes were in Iyengar yoga, which concentrates on alignment didn't make me feel threatened or fat.
My dentist makes me a bite guard that I wear at night to keep me from clenching my jaw and grinding my teeth at night. It's a soft plastic that fits over the lower teeth. It's comfortable to wear. I sometimes wear it during the day, when I'm having a clench-y day. It wears out every 6 to 12 months, and they take a new impression and make a new one. It was $125 the last time and was covered by dental insurance.
I think that regular exercise helps, too. It doesn't have to be vigorous, just regular. My dog walks me every morning. I'm not allowed to linger over the funny papers and a second cup of coffee. It's pretty slow going; he has to check on every mailbox. But it gets me outside, in the fresh air and natural light. I get to check out all the neighbors, too. We've switched from 2 miles to only a mile as he's gotten more arthritic -- he's almost 15. I've also got an exercise bike that I ride often.
Have you seen a counselor or psychologist? I saw one for a good while after I had to give up my law practice because of my head. I'd had much of my self-worth tied up in my career, and Anne helped me work through most of that. I also have Major Depression, and I take antidepressants. Some antidepressants can be good preventives, and I think my antidepressants are part of my preventive cocktail.
I've never seen a pain management doctor. My son saw one for a ruptured disk, but he doesn't treat headaches. I've also never done biofeedback. I've seen a chiropractor on 3 different occasions, and while they helped with other problems, they were sure they could *cure* my migraines. They didn't.
As you said, there's always something else. You may have reached your doc's comfort level, and you may be at the point to find a different doc with a different comfort level. But we can't give up. If we do, the migraines have won.
Gretchen
3/ 4/07 7:18am
2/11/08 1:32pm
I have suffered with migraines since 1973. Long gone are the days where I lost severals days out of the week and was given demerol and pherergan. Imitrix has been a miracle drug, but have found that the Botox injections I have received for the last year, has cut the severity of my headaches.
Plastic surgeon friends have many patients reporting a major decrease with their migraines.
My neurologist doesn't use the facial Botox A. Although this time around I'm not having my neurologist inject my forehead and will let my plastic surgeon friend inject Botox A (as an experiment) to see if the results are different.
Good luck and don't forget to skip any meals.
4/24/08 11:02am
I have been having botox for my migaines/daily headaches for 3 years now with no side effects. The pain relief is amazing and I take hardly any analgesics (this following a 23 year period of never being headache free, headache 24 hours a day every day)! It is the best thing that ever happened to me and I would highly recommend it for your migraines. Mands
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Hi there,
I understand how you feel... my neurologist has been telling me the exact same thing for the past few visits: that we've tried all the preventives and that she's run out of ideas. Aren't doctors supposed to encourage us? I just want to wish you good luck, we will find an answer one day!
Take care,
Jenn