A life-changing treatment for migraine
Osterville resident Judy Liuzza had her first migraine 30 years ago when she was pregnant with her daughter. After her daughter was born, the migraines went away. They returned with a vengeance 28 years ago when she was pregnant with her son and never went away. She was living north of Boston at the time and saw 10 to 12 doctors over the years.
Liuzza tried all of the medications available and none of them lessened the 27 migraines she was having every month. Her quality of life was terrible. When her children were growing up, she had to spend days in her bedroom with the shades down until the migraine passed. She finally found some relief eight years ago through Botox® treatments and experienced a significant reduction in the number of migraines she had.
When she moved to the Cape two and a half years ago, Hyannis neurologist Karen Lynch, MD, continued her treatment.
“Now with Dr. Lynch I’ve been getting the Botox every three months for two and a half years and I would say that, out of 30 days, I might have a headache maybe seven to 10 days a month,” Liuzza said. “Some months are better than others.”
She knows that it doesn’t make sense to those who don’t suffer from migraines, but that reduction has been life-changing for her. Her quality of life has improved dramatically.
Even though to most people seven to 10 migraines would still seem unbearable, Liuzza’s reaction to fewer migraines is not uncommon, according to Dr. Lynch, who practices at Neurologists of Cape Cod on North Street in Hyannis.
“I think that part of the expectation depends on how severe the patient is,” she said. “Those patients that I have who have chronic migraines that have been through the gamut for many years sometimes sell themselves a little short as to what they expect, in part because they have not had much offered over the years.”
Until Botox® (and specifically Botox brand) was FDA approved in 2010, doctors did not have any specific approved medications to treat migraines. They could prescribe other medications like blood pressure pills, anti-depressants and medications used to treat epilepsy. None of them worked very well and they often came with intolerable side effects.
Dr. Lynch expressed dismay that for an illness that has been so prevalent, the medical field has only really just begun to make some breakthroughs in medication options in the last two decades.
She cited statistics from the World Health Organization (WHO) that migraine is the third most prevalent disease in the world. More people suffer from migraines than those suffering from diabetes, epilepsy and asthma combined. The WHO asserts that chronic migraines are as debilitating as quadriplegia and active psychosis.
Can Last For Days
Chronic migraine is when patients have more than 15 headaches a month for more than three months, eight of which are migraine, according to Dr. Lynch.
“When somebody is in an acute migraine state, it’s just as bad as if they have lost their limbs or are in a psychotic state,” she said. “So it’s extremely debilitating as well as the financial burden that it places as regards lost work time, ER and doctors visits.”
Part of the reason that migraines are so debilitating is that they can last for days, beginning with events which include fatigue, yawning, appetite changes and a visual aura. The aura can include scintellating scatomas, vision floaters, orbs, spots, loss of vision, and sometimes more dramatic neurological symptoms such as weakness, numbness down one side of the face or limbs and speech difficulties.
“Some people may look like they are having a stroke, so may end up in the emergency department for their first migraine,”she said.
Botox treatments are given every 12 weeks at the neurologist’s office because the drug wears off over time. It involves a series of very small superficial injections given to various points around the head, including the front and back of the head, along the neck region and across the shoulders.
“Most people will report the headaches are generally less frequent and less severe (after Botox treatment),” Dr. Lynch said. “And often we see super-responders where you get complete resolution from headaches or very minimal headaches and the triggers that used to trigger them don’t trigger them anymore. So it’s a very effective treatment.”
New Treatments Coming
The good news is that more treatments for migraines are both available and on the way. Neurologists of Cape Cod already offers sphenopalatine gaglion blocks, which can be effective for patients, especially for those who experience migraines in the face or eye region. In January 2019, Dr. Lynch expected to begin to introduce other types of nerve blocks, including occipital nerve blocks, greater auricular nerve blocks and supraorbital nerve blocks.
And finally, there are other medications that have been granted FDA approval, including three in the past year, with more expected to gain approval next year and some very promising trials that are underway.
“It’s a very exciting time for migraines sufferers, and in the world of headache medicine,” said Dr. Lynch. “Just this past year we’ve had a new swath of medications that have come out, specifically for migraine.”
The medications are known as CGRP monoclonal antibodies.
“They are a very exciting group of medications which are specific to migraine and they treat both episodic and chronic so it’s really put a big spotlight on a condition that has been quite forgotten about for quite a long time in terms of therapeutic options and management,” she said. “Many migrainers that I see have been sitting in the wings for many years, sometimes decades with really not a lot of treatment options and it’s been quite rewarding to start to be able to offer a lot of these treatments and get excellent effects.”
For Liuzza, the Botox treatments have helped immensely, but she is also grateful for all of the help Dr. Lynch has provided her.
“She explains everything to me and told me I’m not the only person who suffers this many migraines,” she said. “When I was going to the other doctors I thought I was the only person that had 27 migraines a month. I had no idea there were other people like me. At this point the quality of my life is so much better than it was prior to moving here.”