Botox, Baby!

I haven’t written about my personal migraines lately, but they’ve been getting worse. Bad enough for me to decide to try out Botox for Migraines. I was scared silly about this. I knew that most people had significant pain with the Botox and my neurologist mentioned when she had it she heard crunching. That alone made me terrified. At the same time though, I am sick and tired of migraines and ready to try something new.

So at my August appointment, I talked to my neurologist about moving towards Botox. She set the wheels in motion for me to get it done. First, my insurance had to approve it. My insurance says the following about Botox for migraines:

“Botox requires a prior authorization but will generally be approved when the following criteria are met:

1. Chronic migraine (defined as >= 15 headache days/month lasting >=4 hours a day) despite standard treatment including three or more preventive treatments (e.g., amitriptyline, topamax, verapamil and betablockers) or medical contraindications to one or more of these therapies.

2. Prescribing by a headache specialist who has received training in the injection technique.”

I have been on three (now four) preventative treatments. None of them have done much. So I figured approval would be no problem. FALSE. It took over 6 weeks for my insurance to approve me for treatment. But they did on October 7 and notified me (and my doctor) on October 13. I immediate called the “neurotoxin scheduling line” to schedule and they were able to get me in on October 18 (instead of the 3 to 4 months I’d been told to expect).

So I started reading. And I became even more fearful. All the forum postings I read were apparently from people who’d had horrible experiences. The side effects seemed scarier than normal. (See http://www.allergan.com/assets/pdf/botox_pi.pdf) And I didn’t understand how it worked.

Botox for migraines helps to weaken or paralyze the hyper activated muscles by suppressing the release of acetylcholine, which mainly causes the transmission of nerve impulses at synapses and myoneural. This treatment can also be used for reducing the pain associated with the cervical dystonia, achalasia and rectal fissures. Botox is usually injected directly into the affected muscles.

There are different theories to explain the working of the Botox for the elimination of migraine headaches. According to one theory, as tension and spasms are the main causes of migraines, Botox eliminate the headaches by eliminating the muscle tension. It is also believed that Botox reduces the headaches by inhibiting the transmission of nerve cells. According to this theory headache is caused due to the increased amount of signals send by the nerves.”

Article Source: http://EzineArticles.com/341913

AND REMEMBER THAT THIS IS A NEUROTOXIN. That in other forms KILLS PEOPLE. BEING INJECTED INTO MY HEAD. OMG! THE TERROR. Seriously. I was freaking out. So I made Ben come with me. (Plus it was in the uber-burbs, so I had to take his car or he had to take it!)

I met with a very nice doctor (not my normal doc, she doesn’t do botox injections) and his medical student from UMN. They talked to me, having already reviewed my files, and looked over my headache diary. The fact that I’d never had a single day in the past year that was pain-free without medication was almost shocking to them. They said that it sounded like I had little to lose and lots to gain. Then they examined me, testing how well my head moved, where I was tense and confirming where my headaches were. (My headaches are on both sides of my frontal lobe, btw.)

Then they went to talk and I went to the actual doctorish room (instead of an office with a zombie book on the desk). Then they started with the shots. I actually had to lie down because I’m too tall (albeit NOT EVEN 5’11”!!!). Then he took his gloved hands and started injecting me.

Here’s where I got shots.

From the front. I got 7 shots.

Front

From my right: two shots.

Right

From my left: two shots.

Left

He chose these locations based on the stiffness and soreness in my head. He felt that my neck wasn’t tense enough at this point to inject it. That’s something we’d consider a second time if this doesn’t work very well.

It hurt very little. Less than my flu shot last week. (Although the doc kept dabbing something off my face. Blood? I had no sounds that were gross or anything.

I won’t see the effects for another 1-8 days, but I’m feeling better this afternoon than I have in a few weeks. (This morning was miserable, but…) It’s supposed to last for about 3 months. If I get 1/3 fewer headaches for 3 months, it’s worth it to me. It was definitely an experience though. I’ll keep you updated!

Oh, and PS. My forehead is already less wrinkley 😉 (My doc promised I wouldn’t look like Joan Rivers though, thank goodness!)

Migraines and Politics

(Written in late July)

I’ve been pondering a news cycle the last few days. The story is about Michelle Bachmann’s migraines. If you haven’t read the stories, the original one that I read is here and a follow-up is here.

The gist of the story is that apparently Michelle Bachmann has migraines. She and her doctor say they’re under control, but she’s had to be hospitalized for them before and people are concerned that she won’t be able to do the job of president because of the migraines.

Then on today’s flight I read an oped in the Times. (Yay for Economy Comfort and free NYTimes!)

The op-ed is by a migraineur and she talks about the fact that even when migraines are under control, they are never completely under your control, due to the very nature of migraines. She also is concerned that the preventative medications that Bachmann uses are never named, likely because of the fact that most of the meds are generally used for mental health. So there’s also a problem with stigmas.

So this for me isn’t about Bachmann. I’m not going to talk about her politics here. But I think that this is an interesting issue, for multiple reasons.

First, obviously I have personal interest in migraines.

Second, because migraines disproportionately affect women and women haven’t been proportionately represented in US politics, I think this is a unique issue.

Third, the tie between mental health and migraines is important. Both in terms of finding triggers and in terms of pharmaceuticals. But because mental health is still a huge stigma in the US, especially for women (as it signifies weakness), this is a big problem.

Fourth, while Bachmann is getting treatment, most people aren’t. That’s a problem. And even if people do want treatment, it’s expensive and incredibly difficult.

Finally, the fact that migraines are ever changing, ever evolving, and different for everyone affects both diagnosis and treatment.

So the story really isn’t Michelle Bachmann. It’s about how people can cope with migraines. And why they choose to. (I hadn’t mentioned that part before, but I’m pretty sure running for President, let alone winning, would set my migraines on HIGH ALERT.) But the story is only out there because there’s a public face. And it’s a polarizing face.

Migraines aren’t sexy. They won’t (generally) kill you. But they’re there and they’re normal and there is help. But you still have to take care of yourself as well.