Botox and the Superstitions of Chronic Illness
I'm scheduled for Botox injections this afternoon. I've spent the last couple weeks considering canceling the appointment.
My hesitation was fueled by superstition -- I've felt pretty good the last six weeks and I'm afraid to do anything that might mess it up. Just like the baseball player with an elaborate ritual at the plate, I'm grasping to an illusion of control.
Initially I was worried that the injections themselves would trigger a migraine, which happened the last two times I tried Botox. Within an hour of the injections, I had the worst migraine I'd ever had to that point. I don't recall how long they lasted, probably just a day or two, but I remember the pain clearly. After those initial migraines,the Botox did not appear to have any impact, positive or negative.That was eight years ago, though, and my doctor now uses more of the drug and more injection sites. This new protocol is what convinced me to try again.
My conviction wavered after I discovered that the _proof of Botox's efficacy for chronic migraine is pretty weak. In the two studies that Allergan, the maker of Botox, submitted to the FDA, the results are less than stellar. Over a six month period, the participants who received Botox averaged 7.8 and 9.2 fewer days of migraine than before the injections. Participants who had a placebo injection reported 6.4 and 6.9 fewer migraine days. There's not much difference between the actual drug and the placebo. The numbers are an average -- some patients have no reduction in migraine days while others experience a significant reduction.
Lack of evidence supporting a treatment isn't usually enough to keep me away. I've drunk scorpion tea, after all. I'm willing to try any treatment unless it is likely to harm me and the risks of Botox for chronic migraine are very slight. The primary side effects are headache and neck pain, but there's also a chance it will relieve the neck pain I already have.
I was hoping to find clear information that would make my decision obvious. I did not find a resounding endorsement in the research, though plenty of people on forums and who read this blog say that Botox brought a miraculous improvement.
In any case, when I awoke at 5 a.m. today with a migraine and realized it was my sixth migraine in six days, my decision was made. I'll get the Botox injections. In the last six weeks I have felt better than I was before, but the migraines are still chronic. The Botox could push me into a slump where the migraines worsen again, but I might hit it out of the park. I'll never know unless I try.
Can you tell when a migraine attack is coming?