Frequent migraines are not different from chronic migraines
Botox is approved by the FDA for the prophylactic treatment of chronic migraine headaches. Chronic migraine was arbitrarily defined by headache researchers as headache occurring on more than 14 days each month. Epidemiological research by Dr. Richard Lipton and his colleagues at the Albert Einstein School of Medicine suggests that there is no biological difference between frequent migraines that occur on 10 or more days each month and chronic migraines.
They compared clinical features and the incidence of other chronic medical conditions in three groups of patients with migraine: low frequency (0-9 days/month), high frequency (10-14 d/mo) and chronic migraine (15-30 d/mo). The American Migraine Prevalence and Prevention Study is a US-population-based study with 16,573 people with migraine who responded to a 2005 survey. Of these, 10,609 had low frequency, 640 had high frequency and 655 had chronic migraines. Rates of pulmonary and respiratory conditions including asthma, bronchitis, chronic bronchitis, emphysema/COPD, allergies/hay fever, and sinusitis increased across headache frequency groups and were significantly different for chronic migraine vs. low frequency, but not for chronic migraine vs. high frequency. A similar finding was seen for cardiac conditions and strokes. Depression, nervousness or anxiety, bipolar disorder/mania, and chronic pain were also much more common and similar in those with frequent or chronic migraine compared to those with low frequency migraines (around 30% vs 15%-18%).
These findings suggest that patients with frequent migraines resemble those with chronic migraines much more than they do those with low frequency migraines. One practical implication of this research is that Botox is very likely to be as effective for patients with frequent migraines (those with 10-14 headache days a month) as it is for patients with chronic migraines. And indeed, I’ve observed an excellent response in patients with frequent migraines in my almost 20 years of giving Botox injections for headaches. The response for both patients with frequent migraines and chronic migraines is about 70%, which significantly exceeds the efficacy of any prophylactic drug with no potentially serious side effects seen with most drugs.
Art credit: JulieMauskop.com
Hi Morgan,
I cannot make any specific recommendations without seeing you first, but here are some general ideas to discuss with your doctor. We usually start with regular aerobic exercise, low carb diet, elimination of caffeine, biofeedback, magnesium, CoQ10 and other supplements. Most insurance companies will not pay for Botox unless you first tried and failed at least 2 preventive drugs, such as an antidepressant, a blood pressure or an epilepsy medicine. For menstrual migraines we often try continuous contraception (if you do not have auras) and for weather related headaches, Diamox sometimes helps. I hope this helps.
Hi Dr. Mauskop:
I really love reading this blog, and appreciate how current it is with information and research.
In the past few years I have inherited migraines/chronic headaches from my mom & grandmother, and I have developed severe anxiety about them that causes “brain zaps”–making me even more worried I am having a stroke or something! I would say in one month i have a headache 20 out of 30 days. But I only have a legitimate throbbing migraine maybe one or two days. I mainly have a dull frontal headache most of the time and neck pain, and I have tried to keep my triggers down (some I can’t control like weather and menstruation–BUT it doesn’t always trigger one–FRUSTRATING!), but I feel like I keep spiraling out of control and let the headache be in charge of my life. I am having a really hard time. I don’t know if I am rebounding (I’m worried Im taking triptans when it’s not a true migraine, but my headaches doesn’t always respond to OTC meds), or if it’s the anxiety, or what. I am waiting to see if my insurance covers Botox, as I am hopeful it will help with my overall issues.
If you have any ideas I would be much appreciative to hear from you. Or any literature or things I can research. Thanks!