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Before Botox for Migraines

By Sara Calabro

Migraine sufferers began their weekends on a hopeful note. On Friday, the FDA announced that it has approved Botox for the prevention of chronic migraines.

However, the jury is still out on whether Botox actually helps migraines. One study published this summer uncovered no significant reduction in headache episodes between people who got Botox and those who received placebo injections.

Future studies may confirm Botox as a significant advancement in the treatment of chronic migraines, but until evidence is more conclusive, people should consider acupuncture.

Migraine Headaches Can Come from Trigger Points

Trigger points—sensitive nodules in the skeletal musculature that cause referred pain—are to blame for a high percentage of pain complaints. Acupuncture can release these nodules, causing a significant reduction in pain. This is especially noteworthy for migraine sufferers.

In her book Myofascial Pain and Dysfunction: The Trigger Point Manual, author Janet Travell says of her research, “those with upper body pain or headache were more likely to have myofascial [trigger point] pain than patients with pain located elsewhere.”

In other words, a lot of pain comes from trigger points, but especially migraine pain.

Migraines can be caused by trigger points in a number of different muscles, including the sternocleidomastoid, trapezius, digastric and other anterior neck muscles, suboccipital, cervical paraspinals, scalenes, and levator scapulae.

Often, more than one muscle is involved. A total pattern can form from overlapping pain referral patterns from different muscles, causing the pain to spread beyond the traditional pattern of just one muscle. This kind of multi-muscle referral pattern is common in migraines and chronic tension headaches.

Acupuncture Is a Safe, Low-Cost Treatment Option for Migraines

Since Botox essentially works by dulling nerve signals to the muscles, it carries the risk of those effects extending to nearby areas. This can result in life-threatening side effects such as difficulty swallowing or breathing.

Incidence of these side effects is low. According to the FDA’s press release on the approved migraine indication, “There has not been a confirmed serious case of spread of toxin effect when Botox has been used at the recommended dose to treat chronic migraine.”

Still, Botox requires introducing foreign substances into the body, which means adverse reactions are always a possibility.

It’s also expensive.

Allergan, the manufacturer of Botox, has not said exactly how much the migraine treatment will cost. But The New York Times reports that the recommended 31 injections, given at three-month intervals, will cost $1,000-$2,000 a pop. The FDA approval means that many insurance companies—but not all—will cover it, although those that do could require a hefty co-pay.

Even comparing the low-end estimate for Botox with the high end for acupuncture, around $100 a session, acupuncture still amounts to a significant cost savings.

Multiple acupuncture treatments are usually necessary to completely alleviate trigger points and address underlying causes of migraines. The number of required acupuncture treatments depends on a person’s migraine chronicity and severity, as well as constitution and lifestyle.

Typically, three-to-five acupuncture sessions results in noticeable improvement, and it is not uncommon for a trigger-point release to cause immediate migraine relief after just one treatment.

In addition to saving money upfront, migraine patients who opt for acupuncture over Botox may experience longer-lasting results, since acupuncture eliminates the problem rather than temporarily masking it. This ultimately saves even more money over time.

Until we learn more about the efficacy of Botox for migraines, acupuncture is a highly effective option that’s safer and significantly less expensive.

Photo by Sara Calabro

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Comments

rob benhuri
Reply

At the risk of sounding judgmental: it is totally astounding to me that people are willing to inject botulism into their faces. I understand migraines are a crippling problem, and more than anything it just speaks to how desperate people are for relief I suppose. But knowing that botox may well be a placebo, it sure seems to me that I would try acupuncture (and almost anything else) first.

c taylor
Reply

i guess i will have to speak the obvious… Doctors are trained professionals in the management of pain, remedies, cures, etc.. I feel our DR has our best interests at heart and perscribes Botox or other treatments based on strict medical research and approved methods. I do not believe they use Botox because they own the company’s stock or get kick backs. accupuncture is a last ditch effort when you are grasping at straws. i believe some people do benefit from it or atleast percieve that they do… where are the lengthy clinical studies? the REAL medical industry has not embraced this procedure for a reason.

Sara
Reply

Thanks for contributing your opinion, c. I’m not sure from where your comment regarding company stock and kick backs comes, as there’s no mention of either of those things anywhere in this article. But your two cents are appreciated, nevertheless—all sides of the debate over acupuncture’s efficacy are welcome on AcuTake. Perhaps some other readers will share their opinions in response to yours.

Best,
Sara

Deidre
Reply

C -

Interesting perspective. However, here is some information from the World Health Organization, which also mentions a report from the NIH, regarding the efficacy of acupuncture – http://www.essentialhealthcare.com/info_for_practitioners/efficacy.html

I’m not sure who you consider to be the “real medical industry” but I think both of these organizations would fall into that category.

In addition, while this article (http://www.newsytype.com/5938-pharmaceutical-kickbacks-plague-medical-industry/) is from a less known source, it does cite reputable sources in its discussion of the fact that doctors do not necessarily work entirely without at least the temptation of incentives.

Casey
Reply

C – I agree with your opinion that doctors have our best interests at heart. I believe there are a couple of underlying issues, one which you bring up. As mentioned drug companies spend a lot of money on trials for their drugs in order to have them approved. That kind of money is not there for acupuncture research so there is less evidence in the form of clinical trials. The point I think the article and some of the other commenters are trying to make is that while we don’t have clinical trials to support acupuncture use for migraines, we have thousands of years of clinical experience. And since acupuncture is a very safe therapy it should be better utilized rather than jumping to potentially risky and not fully supported therapies like Botox injections. If acupuncture fails to achieve results you can always move onto other therapies. But can you reverse side effects from Botox and other drugs? Can you undo surgeries?

Another issue is that Botox is within the MDs toolbox, acupuncture is not. Doctors want to use what they know and understand and will use the tools at their disposal before referring their patients. As the acupuncture profession grows and doctors become better informed about acupuncture I think we’ll see this trend changing. C – while you seem to be a bit of a naysayer I at least appreciate the fact that you are reading up on acupuncture rather than discounting it altogether.

Luis David Suarez
Reply

c taylor: Even the NIH and the WHO that are normally not embracing therapies other than drugs recommend acupuncture for the treatment of migraines, given it’s lack of side effects and high efficacy. Botox injections that produce paralysis of muscles might be effective to treat migraine but as the article says, the introduction of foreign substances in the body is more likely to produce unwanted or dangerous side effects than the neuromodulation involved in the mechanisms that acupuncture triggers that involve pain relief such as endorphin release, cytokine modulation, and muscle relaxation, not muscle paralysis that though transient, can be a common adverse reaction of Botox, at the very least preventing you from smiling and frowning.

Joy Healey
Reply

I used to suffer dreadful migraines, but would have great reservations about using Botox. A friend tried it (for cosmetic reasons) and was not happy with her experience. Obviously that’s anecdotal only and I appreciate that other people may have been very happy.

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