It may not shock you to know that I have tried Botox, given my geographical location and all. What may surprise you is that I don’t do it for cosmetic purposes. In fact, it doesn’t go in my forehead or frown lines or crow’s feet. It actually doesn’t go anywhere on my face at all. I don’t even go to a dermatologist or plastic surgeon to get it injected.
Stumped? Well, you shouldn’t be. Because if you are one of the 30 million women in the U.S. alone that suffers from migraine headaches, then perhaps you understand why I get the toxin at all.
Scientists believe Botox works by blocking the protein that carries the message of pain to the brain, although they are not entirely sure if this is the case. This mechanism of action is completely different than how the drug works when a physician injects it into muscles, such as an overactive neck spasm or a facial frown or wrinkle, where it blocks the nerve impulse to the muscle. How Botox works to relieve migraines is actually kind of a mystery.
All I know is that it works.
I twittered about it last week after I got my injections (about thirty in all) on Friday and I have received numerous requests for more information. I’m happy to share my story and hope it will help others.
First off, you have to get over your fear that you are injecting a toxin that can kill you into your body. Yea, it’s scary and all. Blah blah blah. I guarantee you’ve probably been through worse in your life.
The chances of the Botox getting into your bloodstream is nil AT THESE DOSES so get over yourself. In fact, it is extremely rare that the Botox would spread away from the injection site when used for migraine purposes, contrary to reports you may have heard on Oprah (the ultimate resource for correct information) or in the Enquirer. So chill the hell out. (The cases that made the news were primarily in Cerebral Palsy patients at much, much higher doses and injected intramuscularly.)
The amount they use is so tiny and they inject it right under the skin (temples and temporal muscles—by your ears) with such small needles that the Botox stays in the small area where it is meant to work. *If you get your headaches across your forehead, you will get injected there and get the cosmetic benefit there as well. Nice. I just happen not to.
See, the whole point of getting Botox is to paralyze or stop a muscle from working, or feeling pain. That’s why movie stars and “ladies who lunch” love it so much—no more crow’s feet, no more frown lines, and for me, no more headaches.
Well, kind of.
See, I can still FEEL that I’m having the headache. I get the light sensitivity, nausea, stomach upset, and tight muscles. I even still feel the pressure in my head. But I don’t feel the horrible, throbbing pain. I don’t have to lie down for hours. I can function.
And that, my friends, is a godsend.
Oh, about the needles. Yea, that sucks. I hate needles. Who doesn’t, right? Most docs now that inject Botox (and trust me, I was a pharma rep for 15 years—my advice is to go to a highly-respected neurologist who does this A LOT) use little, bitty needles that hardly hurt at all. Well, I mean it hurts, but not like flu-shot hurt.
However, when it comes to injecting into my shoulder and sub-occipital area (lower head in the back) where I get chronic spasms from something lovely called cervical dystonia (a condition where I have chronic neck spasms due to a past injury—damn pharma samples used to come in glass bottles. We’re going WAY back here), they have to use a realllllly long needle to inject the Botox deep into those muscles. My doctor uses a cool little machine when injecting these needles into the muscles called an EMG(Electromyography), which measures the conductivity of the muscle as he’s injecting. A great tool in helping him know that we’ve hit the right muscle.
Dystonia (also called torticollis) happens to be an approved indication for Botox, so if you have this accompanying neck tightness or spasm also, it should be covered by your insurance company.
Unless you live in California and have MY insurance, Anthem Blue Cross PPO. Without going in to all the gory details, my lovely insurance company has denied any and all claims for approving Botox, whether or not it’s for migraines (still an unapproved indication although some insurance companies WILL cover it due to the cost vs. effect ratio as well as the plethora of evidence that der, it WORKS) or the actual approved indication, dystonia. This is, of course, totally against state guidelines and there is a class-action suit currently underway against them for denying claims for approved indications. Somehow, a few claims have been approved. (Some for .98 cents. Don’t even get me started. I pay for some of it. My doc takes a write off on some of it. Just FYI: his office manager Ann-Marie speaks to offices all over the country on how to get Botox covered. Yea, they’re that good.)
That said, my neurologist, Kenneth Martinez, M.D., has been extraordinary in helping me get these migraines under control. What makes him different than other neuros are a few things: a) he’s the first physician to prescribe estrogen for me. It’s a low-dose patch and it’s made a WORLD of difference. b) he has me take a low dose of Periactin, an old-school anti-histamine that’s been found to have preventive effects on migraines—I don’t know how; and c) he holds Botox Clinics every three months like clockwork for his migraine patients. Botox wears off after three-four months; it also has a cumulative effect on your muscles and nerves—so by injecting regularly you are “training” these areas, if you will. Sounds science-geeky to me but I’m here to tell you that it’s way more effective when I don’t skip a clinic.
I’m 46 now. I’ve had migraines since my mid-20s. As a former pharma rep (I quit in 2004) and trainer, I am probably more informed than most people in that not only did I call on neurologists (and physicians in general), but I also know how drugs work and how insurance companies work.
I hold no illusions that this makes me smarter than you. I also don’t think this makes me a doctor (thank God). However, I do know what makes a smart, informed doctor when it comes to migraines. (Look for someone who specializes in migraines; who has published papers on migraines; who doesn’t shy away from using hormones or Botox; who is young—older docs tend to stick with older, less effective ; who goes to conferences; who doesn’t prescribe opiates regularly, and who talks to reps. In my experience, those docs that never talk to reps are not open to new information. Just my opinion.)
I went to A LOT of neuros over the years and I’ve tried A LOT of different therapies, both drug and non-drug (acupuncture, biofeedback massage, Reiki), eastern therapy (herbs, teas) and western therapy (physical therapy, Pilates, weights, epidural injections). I spent a lot of money. I know now what works for me—and clearly, what doesn’t.
Here is my personal regimen. If it helps you or is something you want to talk with your doctor about, great. If you have questions for me, fine. Ask away.
This is my prophylactic (oh, grow up), a.k.a. preventative, regimen:
- Botox injections, every three months
- Topamax, twice a day -- Rx
- Metanx (Vit B combo), twice a day –- Rx
- Climara Estradiol Patch, once weekly –- Rx
- Periactin (anti-histamine) @ bedtime -- Rx
- Petadolex (Butterbur), twice a day –- OTC
- CoQ10 (decreases inflammation)–- OTC
- OsCal-D (Calcium + Vit D) -- OTC
- Advil or Aleve, no more than 3 X/day, 3 days prior to my period –- OTC
Okay. Now, if I GET a migraine, which I still do, but nowhere to the horrible, debilitating degree at which I used to, here’s what I do:
- Relpax (a triptan) –- Rx
- Skelaxin (muscle relaxer) –- Rx {a newer class of muscle relaxers that doesn’t make you as loopy as the older ones like Soma or Flexeril}
- Advil or Aleve as needed, sparingly, so as not to initiate a rebound cycle.*
*A word about rebound cycles. If you are self-medicating with Excedrin Migraine, Tylenol, Advil, or an opiate like Vicodin or Fiorinal thinking “I don’t have migraines. I just have the occasional headache.” Get real. You are putting yourself in a rebound cycle. You keep getting headaches because you keep taking headache medications. You cannot end this cycle by simply stopping the meds cold turkey. I guarantee you the pain will be stronger than your willpower. I know. I’ve been there. Get help.
A word about opiates. If your family physician (or god forbid, neurologist) is writing these drugs for you to “control” your migraines, RUN. You are setting yourself up for an unnecessary lifelong addiction to painkillers, if you don’t already have one. I have taken these meds for my headaches and I’m here to tell you, the more you take, the more you need them. If you’re taking them now, you are nodding your head as you read this. My regimen above is the only accepted regimen for migraines and opiates have no place in there. Look it up yourself.
I realize my statement above will scare some people. Particularly if they are addicted to painkillers for their migraines. Oh well.
Finally, I cut out sugar, dairy, and red wine from my diet. (Nobody touches my vodka though I have to limit myself to only one occasional dirty martini. Yum.) I limit myself to one precious cup of coffee per day--and it’s a big cup. I take lots of walks since I live by the ocean and now have a new puppy. Yay me. I’m just getting back into thinking about doing Pilates and Yoga. Hehe.
So that’s my story and I’m sticking to it. The Botox takes about about a week or so to kick in, sometimes sooner. I wish sooner, since I’ve had a headache all day writing this.
Bummer.
If you have any questions for me or want to contact me in a more private manner, feel free to leave me a comment as such and I will get back to you. If you are on Twitter, leave me a tweet or DM if we follow each other (@RachelintheOC).
