Definition of chronic migraine
Chronic migraine is defined as experiencing headaches on 15 or more days per month for at least 3 months, with at least 8 of these days having migraine features. This definition is a criterion of the International Headache Classification (ICHD-3). A disease at this level seriously affects work, social life, and family relationships.
The treatment of chronic migraine is multi-layered: trigger management, acute attack medications, preventive oral medications (topiramate, propranolol, amitriptyline), lifestyle adjustments. In patients who do not respond sufficiently to these layers, botox and CGRP monoclonal antibody treatments come into play.
PREEMPT protocol
Botox for migraine is applied with a standard protocol: PREEMPT (Phase III Research Evaluating Migraine Prophylaxis Therapy). This protocol is completed by spreading a total of 155 units over 31 areas. Areas: forehead, temples, back of the head, upper neck, trapezius. This wide distribution is different from aesthetic botox and its purpose is to silence the nerve networks in your muscles.
Treatment is repeated at 12-week intervals. International guidelines recommend evaluating the response after 3 courses: if the number of painful days per month has decreased by at least 50%, treatment is continued; if not, alternative treatments are switched to.
Clinical note:Botox for chronic migraine is not a treatment that an aesthetic physician can independently apply. First, a neurologist must diagnose, determine the medical treatment history, and establish the indication. In my clinic, I do not apply botox for migraine without a neurologist's referral.
Side effects and expectation management
Most common side effects: pain at the injection site, neck stiffness, temporary increase in headache (in the first 48 hours), temporary drooping of the eyebrow or eyelid. Most of these resolve within 1-2 weeks. Serious side effects are rare.
Managing the patient's expectations is critical. The question "Will my migraine completely disappear?" is frequently heard. The answer is: the goal is a significant reduction in the frequency and severity of migraine; it is not to eliminate migraine. For a patient who has 180 painful days a year, reducing this to 60-90 days a year is a revolution in quality of life. With this realistic expectation, the patient manages the process more healthily.
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