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Joey Wahler (Host): Migraine is a neurological disease that can cause debilitating headaches and other symptoms. But did you know that Botox injections, often associated with reducing wrinkles, are now being used to treat migraines? So we're discussing Botox treatment for migraine relief.

This is McLaren's In Good Health, a podcast sponsored by McLaren Health. Thanks for listening. I'm Joey Wahler. Our guest, Dr. Alex Steinbock, a neurologist at McLaren Health. Dr. Steinbock, thanks for joining us.

Dr. Alex Steinbock: My pleasure. Thanks for having me.

Joey Wahler (Host): Same here. So first, what exactly causes a migraine?

Dr. Alex Steinbock: Well, it's a very complex set of neurochemical events that occur. It's actually incompletely understood. We do know that there are some pain-sensitive structures within the head, face and neck that get excited in a migraine attack. And they get sensitized in people that are susceptible to having migraines. And genetics do play a role.

Joey Wahler (Host): So, what are the typical migraine symptoms one experiences?

Dr. Alex Steinbock: We can have anything from what's called a prodrome, which is symptoms that begin before the headache pain begins, including tiredness, difficulty concentrating, sensitivity to light and sound changes in mood, unusual food cravings, or hunger. We can also have something called an aura that usually occurs from anywhere from five minutes to an hour before the headache phase, that would be changes in vision, sensation or speech. And then, the actual headache pain occurs, which is moderate to severe intense pain, nausea with or without vomiting, continued sensitivity to light and sound, sometimes neck pain and stiffness. After the headache, we have what's called the postdrome and that can be from 24 to 48 hours after the headache phase with ongoing headache, tiredness, depression, and sensitivity to light and sound.

Joey Wahler (Host): Wow. That's quite a list. So we hear a lot about the headaches. But obviously, there's a lot that can come along with that both before and after. Now, there are both what are known as episodic and chronic migraine sufferers. What's the difference between those two?

Dr. Alex Steinbock: The difference is the amount of headache days per month. So in a chronic migraine, you count 15 or more headache days a month; eight or more migraine days a month and headaches that last four or more hours per day, that is the actual criteria to diagnose a chronic migraine.

Joey Wahler (Host): And from what you see, typically, what's the quality of life impact on the average patient?

Dr. Alex Steinbock: So migraine is the second leading cause of years lived with disability. And a day with a severe migraine attack is as disabling as a day lived with psychosis or quadriplegia. And it really keeps people from enjoying their daily activities, going to school or work, taking care of their children, really anything

Joey Wahler (Host): So from what you're saying there, it's really very common, right?

Dr. Alex Steinbock: Approximately 12% of the United States population has migraines.

Joey Wahler (Host): Wow. Interesting. So let's talk about this Botox treatment option. I would imagine many people are unaware that this is even something out there right now, right?

Dr. Alex Steinbock: Hopefully, that's not the case. But yes, I do believe that there are people out there that only think of Botox cosmetically. But we use the injections that are placed in and around the head and neck in several sites, in approximately seven head regions. And Botox is a purified form of a toxin that's produced by a bacteria and we use it in tiny doses. What it does is blocks the release of chemicals that are involved in pain transmission, and it also prevents the activation of complex pain networks within the brain itself. The injections are given every 12 weeks and are very effective. Different studies show between 50% and 75% in reducing those days per month that you're suffering from a headache or migraine.

Joey Wahler (Host): So you mentioned the word toxin there, but you also said it's given in very small doses. So I presume this is considered safe if it's now a common treatment, yes?

Dr. Alex Steinbock: It has been on the market for 20 years, I believe. They've had 10 years of studies and data that are very safe and effective.

Joey Wahler (Host): So how does this Botox treatment for migraine compare to other treatments available?

Dr. Alex Steinbock: Well, long-term studies again indicate that Botox is very cost-effective and safe, especially in long-term chronic migraine sufferers, compared to putting medications in your body on a daily basis, doing other types of injections that are available. Highly, highly recommended for chronic migraine sufferers.

Joey Wahler (Host): And so you mentioned treatments typically being offered every 12 weeks. So is that something that would then be done for the rest of one's life?

Dr. Alex Steinbock: It is pretty much an ongoing treatment that is what we call indefinite. Many adults do grow out of migraine headaches as they get a little bit older. I have treated patients into their 70s and 80s, but it is typically considered a lifelong treatment.

Joey Wahler (Host): Wow. Outgrowing it sometimes in your 70s or 80s, doc, it's nice to know you can outgrow something that late in life, right?

Dr. Alex Steinbock: Right.

Joey Wahler (Host): So I wanted to ask you also regarding age and migraine. Is there an age at which you would typically get a first migraine or can it happen at any time?

Dr. Alex Steinbock: It can happen at any time. There has been documented children at age as early as four years old developing migraine headaches. On average, it's a condition of early to middle age, so we're talking 20s to 40s, but anywhere across the spectrum.

Joey Wahler (Host): And you mentioned genetics, family history plays a role in this in terms of your susceptibility, I suppose. How about anything else that people can do on their own to either ease migraine or possibly ward it off altogether if they haven't had it yet?

Dr. Alex Steinbock: I always recommend a healthy lifestyle, proper sleep, diet, rest, exercise, stress management. Those are the basics to try and prevent them and ward them off before they even occur.

Joey Wahler (Host): Gotcha. So how much of your treatment regimen now is Botox compared with medication? Is this a growing option that people are using more as time goes on?

Dr. Alex Steinbock: It is a growing option. And because there are so many chronic migraine sufferers, it is creeping up into at least 50%, if not more.

Joey Wahler (Host): Interesting. So do you think it's just a matter of getting the word out more at this point and making sure people are aware as we alluded to at the top that this isn't your grandfather's Botox, so to speak, or maybe we should say grandmother's? But in either case, it's not the one that's been used for years to do more cosmetic work, right?

Dr. Alex Steinbock: That is correct, everything you've just said. I think that spreading the word, making people aware that it is a safe, effective treatment is the best approach that we have right now.

Joey Wahler (Host): And so to summarize, what would you say is maybe a patient's biggest misconception or apprehension that you can ease going forward if they've been considering this, but haven't quite pulled the trigger? You mentioned it's safe. Anything else you can say that will make people feel more comfortable with actually giving it a try?

Dr. Alex Steinbock: Well, I think that based on my own clinical experience and perhaps talking to some other patients who have had the treatment, it's getting over that initial fear of, "Oh, I am getting injections into my head and neck." It's a very small needle. We use a very small amount of the injection areas and it is something that I recommend to all my chronic headache sufferers. If you've been suffering with these types of headaches for so long, it will significantly reduce the impact migraine has on your life.

Joey Wahler (Host): Well, folks, we trust you now have more knowledge about Botox as a migraine treatment. Dr. Alex Steinbock, thanks so much again.

Dr. Alex Steinbock: Thank you. Have a great day.

Joey Wahler (Host): You too, doc. And for more information, please visit mclaren.org/steinbock. That's M-C-L-A-R-E-N dot org forward slash S-T-E-I-N-B-O-C-K. If you found this podcast helpful, please share it on your social media. And thanks for listening to McLaren's In Good Health, a podcast sponsored by McLaren Health. Hoping your health is good health, I'm Joey Wahler.