Migraine

Aura

For some people, aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They’re usually visual but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes.

Examples of migraine aura include:

• Visual phenomena, such as seeing various shapes, bright spots or flashes of light
• Vision loss
• Pins and needles sensations in an arm or leg
• Weakness or numbness in the face or one side of the body
• Difficulty speaking
• Hearing noises or music
• Uncontrollable jerking or other movements

Attack

A migraine usually lasts from four to 72 hours if untreated. How often migraines occur varies from person to person. Migraines might occur rarely or strike several times a month.

During a migraine, you might have:

• Pain usually on one side of your head, but often on both sides
• Pain that throbs or pulses
• Sensitivity to light, sound, and sometimes smell and touch
• Nausea and vomiting

Post-drome

After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.

Treatments

• Migraine treatment is aimed at stopping symptoms and preventing future attacks.Many medications have been designed to treat migraines. Medications used to combat migraines fall into two broad categories:
  • Pain-relieving medications. Also known as an acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.
  • Preventive medications. These types of drugs are taken regularly, often daily, to reduce the severity or frequency of migraines.

  Your treatment choices depend on the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.

  Over-the-counter medications such as ASA (e.g., Aspirin®), acetaminophen (e.g., Tylenol®), and ibuprofen (e.g., Advil® or Motrin®) can be effective, particularly for mild or moderate migraines.

  There are many prescription medications that can be effective for treating migraines, including triptans (such as sumatriptan, e.g., Imitrex®).

  f you have nausea or vomiting with your migraine attacks, there are options such as triptan wafers, nasal sprays, or injections that may be best.

  Medications containing codeine or another opioid may be necessary at times but are best avoided.

  More is NOT necessarily better. Using migraine medications such as acetaminophen or NSAIDs 15 or more days a month, or a triptan or medication containing codeine or another opioid 10 or more days a month may cause a headache type called ‘medication-overuse headache’.

BOTOX and CGRP Antibodies

CGRP (calcitonin gene-related peptide) is a small molecule that is naturally present in our brains and bodies. CGRP exerts its physiologic action when it binds to its specific receptor. One of the key actions of CGRP is the dilation of blood vessels; it also plays a role in pain transmission

There is strong scientific evidence supporting a role for CGRP in migraines. Intravenous CGRP can trigger migraines. During a migraine, blood levels of CGRP are increased. Blocking CGRP with a pill can stop a migraine attack

CGRP antibodies are designed to bind to CGRP or its receptor and stop CGRP’s function. Four CGRP MABs have been studied so far. They are called erenumab (Aimovig), galcanezumab, fremanezumab, and eptinezumab (sorry for the long names). The first 3 are injected under the skin (subcutaneous), and eptinezumab is administered as an IV infusion (it is not expected to come to Canada).

Multiple randomized studies have shown efficacy for the prevention of episodic and chronic migraine. But not all patients do respond to those treatments. Approximately 50% of patients trying CGRP MABs have a 50% or more response to them. About 25% of patients are «super responders» and improved by 75%.

One of the advantages of CGRP MABs is the low risk of side effects (good tolerability). Side effects are mostly linked to the pain at the injection site. This will be good news for people who have tried oral migraine preventives with common side effects like weight gain, somnolence or cognitive difficulties, which are not reported with CGRP MABs.

Botox for Chronic Migraines

Chronic Migraine headaches cause severe pain that can last for hours, or even days, and cause sensitivity to light and noise, nausea and vomiting, blurred vision and lightheadedness several days per month. They can interrupt your relationships and hobbies and cause you to miss work. There are many different treatment options, including medications and Botox injections,

Botox or onabotulinum toxin A, has been approved by the U.S. Food and Drug Administration as a treatment for chronic migraines. The treatment involves a series of several small injections targeting muscles in your face, head and neck once every three months. The amount injected, as well as injection locations, is adjusted based on your reported pain.