Bangkok Post : FIGHTING MIGRAINES HEAD-ON

HEALTH

Aheadache is a common symptom - so common it is sometimes written off as an insignificant sign. But a headache signals a health issue, sometimes even a serious underlying condition. It can be the result of something as minor as mild stress or something as alarming as a brain tumour. Ignoring headaches can therefore spell danger in some cases.

One of the most prevalent causes of headaches is migraine, which plagues the lives of many people, around 12 percent to be precise. The cause of migraine is not yet clearly understood, but studies have shown that genetics and environmental factors seem to both play a big role. Migraine is characterised by intense throbbing pain on one side of the head and other symptoms such as nausea, numbness, tingling and auras which precede the pain and consist of flashing lights. It is more common in women as sometimes it is related to menstruation.

Dr Sirirat Poonsub, from Dr Orawan Holistic Centre, explained that a migraine headache is due to vascular contraction that results in a reduction of blood flow. The cause of the contraction, however, has not yet been pinned down.

"Nobody knows for sure what exactly causes this vascular contraction, but studies have shown that stress, too much caffeine and lack of sleep may contribute to causing migraine headaches," said Dr Sirirat.

For some people, a migraine headache is a tolerable symptom, treatable with rest and painkillers. However, repetitive migraines could actually lead to certain psychological problems, strokes and depression and severe migraine headaches could lead to serious arterial injury.

Dr Sirirat further explained that in mild cases, migraine patients are successfully treated with pain-relieving medication and cooling pads. However, in more severe cases, these methods aren't sufficient.

"Today, patients with severe migraines seek other options such as acupuncture or BTX-A [botulinum toxin type A] injections," she said.

In theory, both acupuncture and BTX-A - commonly known as Botox after its first trade name - stimulate the various meridien points related to the illness or imbalance. In this case, needles are used at points that trigger the headache. BTX-A causes temporary muscle paralysis, stopping them from contraction. It does so by blocking transmission of acetylcholine - a neurotransmitter which sends a message to the muscle to contract - thereby relaxing the muscle. By injecting the substance at pain-causing points, the contractions stop and the pain is relieved.

Treating migraines with BTX-A is done by injecting the substance at only a few points. By injecting it into the muscles of the brow, eyes, forehead, side of the head or back of the head near the neck, depending on where the pain occurs, patients experience immediate migraine relief for up to six months.

Despite its drastic effectiveness, BTX-A is not the first choice in treating migraines, as it is more expensive compared to medication. One injection can cost around 1,000 baht while medicine costs no more than 200 baht. However, the cost of a BTX-A injection has to be looked at as a six-month treatment as compared to other one-time drugs.

While BTX-A is proven to have a dramatic response, not all migraine patients require such a level of pain relief. At present, only severe cases are recommended for the treatment.

Probably due to advertising, BTX-A is more well-known for its cosmetic use, particularly for skin tightening and jaw reduction effects. Its neurological use is overshadowed by its commercially widespread anti-ageing properties. While BTX-A has successfully treated several neurological cases, such as spasm and palsy, most people still relate BTX-A, or the brand Botox, to cosmetic effects. "In Thailand, BTX-A is more popular in cosmetic circles, and its neurological use is not as widespread as its cosmetic use," said Dr Sirirat, who is experienced in both the neurological and cosmetic use of BTX-A.

She also added that initially it was used to treat crossed eyes, and the skin tightening effect was accidentally discovered later.

Although there are very few reports of side effects caused by botulinum toxin type A, it does not mean patients should trust any doctor, as unauthorised clinics that offer BTX-A treatments exist.

"The concern is not that it could be dangerous - it is only a big waste of money. It is true that BTX-A is not harmful to health, but if the doctor is not skilled enough, the injection could end up in the wrong muscle and therefore cause strange facial expressions," warned Dr Sirirat.

Some patients specifically ask for Botox - the US brand - because it has been in the market the longest. Other popular brands are from the UK, China and Korea.

The largest difference lies in the price, not so much in the effectiveness.

"Regardless of the country of origin, all botulinum toxins, if certified, have almost the same effect. How long the effect lasts, however, might vary from brand to brand. How soon the effect shows is also another common difference," explained Dr Sirirat.

She said that other than anti-ageing and muscular disorders, BTX-A is also used to heal scars, counteract excessive sweating and decrease body odour. Some migraine patients also see skin tightening effects on their skin after being injected with BTX-A.

"BTX-A is a very good option for many conditions. As far as I know, there is no better way to treat spasms and excessive sweating. As for migraine, it shows dramatic results in severe cases," she concluded.

Other story in this series: The future of BTX-A