How are neurotoxins used in treating head pain?

The medication commonly referred to as BotoxTM, and now officially named OnabotulinumtoxinA is one of several neurotoxins used in the treatment of headache medicine.  OnabotulinumtoxinA is the most frequently used and well known neurotoxin of the group.  OnabotulinumtoxinA after years of testing in the headache population has been approved by the FDA as an effective treatment for chronic migraine.  Chronic migraine is that form of migraine which produces migraine symptoms at least eight days per month and headache of one type or another for 15 or more days per month.

Neurotoxins used in medicines are purified neurotoxins from the bacteria that causes botulism; a medical condition characterized by progressive muscle weakness and paralysis, usually the result of food poisoning or a deep wound infection.  Small amounts of neurotoxins injected directly into muscles can cause the muscle to be greatly weakened.  Neurotoxins are used widely in medical practice for a variety of conditions, most involving the spasm of various muscles throughout the body including glands that rely on muscles to exude their substances. 

The mechanism by which OnabotulinumtoxinA provides a benefit to many patients with chronic migraine remains uncertain.  It is not believed to be principally by reducing muscle spasm, but rather through mechanisms involving the brain and other neural structures.  It is not possible to predict in advance which patients with chronic migraine will respond to OnabotulinumtoxinA, but the medication has been widely used when more traditional medicines have failed to provide relief.  Currently only two medicines have been specifically approved by the FDA for chronic migraine treatment:  one is topiramate and the other is OnabotulinumtoxinA.  However, other medications may also be effective for varying forms of migraine. 

Unfortunately, OnabotulinumtoxinA and other neurotoxins are very expensive.  Although the coverage of this treatment by insurance companies has expanded greatly, there continue to be significant restrictions and prerequisites which must be in place prior to their use being approved by insurance carriers. 

MHNI follows a strict protocol developed and approved by the FDA in the treatment of chronic migraine.  For more information, please discuss the use of neurotoxins for your chronic migraines with your primary care physician or your MHNI physician.