a study concerning botox: type of migraine seems to be the relative factor

I copied and pasted this because I'm fairly sure you would not be able to follow the link without a subscription. This is what I found. It seems interesting and useful for anyone considering botox, like me. I'm open to anything that will help. Read it and let me know what you think.

Predicting Migraine Responsiveness to Botulinum Toxin Type A Injections

Christine C. Kim, MD; Megan M. Bogart, MD; Sue Ann Wee, MD; Rami Burstein, PhD; Kenneth A. Arndt, MD; Jeffrey S. Dover, MD, FRCPC
Arch Dermatol. 2010;146(2):159-163.

Our study supports the hypothesis that patients with imploding and ocular migraines are more responsive to BTX than those with exploding migraines. Injections of BTX at doses appropriate for cosmetic purposes may be sufficient to prevent migraine attacks.

Jakubowski et al5 prospectively studied 42 migraine patients to find a neurologic marker that would differentiate between those patients who respond to BTX treatment and those who do not. To their surprise, those who responded and those who did not respond were sharply divided in their descriptions of the directionality of their headache pain. Of the 39 with clear response, 87% described their pain as crushing and vicelike (imploding) or eye-popping (ocular). Conversely, 92% of the 24 without response described their headache pain as a buildup of pressure inside their head (exploding). To test the validity of this finding, a retrospective study was conducted at 2 other headache clinics, in which patients who were already undergoing prophylactic treatments with BTX were interviewed. Again, the only factor that distinguished those who responded from those who did not respond was the description and directionality of their headaches.

The patients who had exploding headaches experienced a mean (SD) reduction in migraine frequency of 11.4 (3.7) days per month to 9.4 (4.0) days per month, whereas migraine frequency in patients with imploding and ocular headaches was reduced from 7.1 (1.4) days per month to 0.6 (0.2) days per month. Using the Wilcoxon signed rank test, BTX effects on migraine frequency were significant for those who responded (P = .002) and for the patients with imploding (P = .005) headaches but not for those who did not respond (P = .30) or patients with exploding headaches (P = .07).

Interesting, perhaps it hugely depends on the nerves involved?

Risa

So what kinds of migraine do you guys have? Mine is definitely imploding.

I think mine is imploding as well....

Mine's exploding. I often think of it as a small person with a big hammer in my head trying to get out.

It is an interesting study, and it would be helpful to be able to predict who might do well, but....I have done Botox since 1998, over 2500 times total, and I still do not think we can predict who might do well..or, for that matter, where to do the Botox, or the dose. I was a participant in the(recently released) Premium trial(you can Google Premium and Botox), where we used 180 units total of Botox, and I am not sure those large doses work any more than my "usual" dose(40 to 70 units total). Larry Robbins,M.D. http://www.headachedrugs.com (we have new articles on the site, and on the doctors blog at the top, and on Twitter..name is doclarryrobbins on Twitter)

jwar wrote:So what kinds of migraine do you guys have? Mine is definitely imploding.

Honestly, both. Lately I have felt like the pressure is pushing out though. The pain seems to settle in the back of my head and just above my eye. The sensation in the back of my head is like all the blood in my body is there pushing out on my skull like a balloon. It sux!