Column: Botox for migraine headache can aid millions of sufferers

Who would have imagined that the world’s deadliest poison, 100 times more toxic than cyanide and deadlier than Sarin nerve gas, would now be used to treat everything from sweaty palms, wrinkles, overactive bladder, chronic migraine, limb spasticity, voice tremor and premature ejaculation?

It is remarkable to think that there have been over 3,200 articles in scientific and medical journals about Botox, which the New York Times calls “medicine’s answer to duct tape.” Time magazine ran a lead article titled “Botox: The Drug That’s Treating Everything.”

Botox received formal Food and Drug Administration approval for its use in chronic migraine in 2010 and is now covered by the majority of insurers for this indication. It was approved earlier for cosmetic use, and its therapeutic use in migraine was discovered by a plastic surgeon who found that his patients not only looked better, but reported fewer headaches.

As many as 35 million Americans suffer from migraines. About 43% of women and 18% of men will experience such headaches during their lives, the majority of whom are ages 35-45. The higher prevalence in women is thought to be associated with hormonal changes.

The global costs associated with migraine headaches in the U.S. are approximately $78 billion. This includes clinical care, hospitalization, diagnostics and medication. Of this, annual indirect costs are roughly $20 billion — over 80% of which is absenteeism as measured by days of productive work lost.

Today, I inject botulinum toxin principally for chronic migraines but also for myriad other conditions. Chronic migraine is defined as severe headache, often with sensitivity to light and sound, present 15 or more days a month. I have found Botox to be exceedingly effective and have been thrilled to see patients who were disabled because of migraines return to work and again be able to care for their families at home. There’s nothing more satisfying as a medical doctor than being able to restore someone to good health and improve their quality of life.

Of course, Botox is but one part of my practice and is only one tool for chronic migraine management. Prior to starting a neurology residency, I spent 10 years doing primary care, and continue to think of myself as a generalist with subspecialty training in neurology, so my approach considers a broad range of options.

The optimal management of headaches involves caring for the patient with a whole-person approach while employing team-based, multidisciplinary care. It is for this reason that I have decided to form the Pacific Headache Center at Manakai beginning in June.

At Manakai, collaborative care for headaches and general neurology might include supplements, dietary counseling, sleep optimization, physical therapy, acupuncture, counseling, manual therapies and medication. In a recent study of 370 patients who suffer from chronic migraine, 90% reported use of integrative medicine while 56% described use of multiple integrative modalities. I am delighted to join this well-seasoned team, which over the past 20 years has carefully honed its operation while treating over a half-million visits.

My approach to patient care is admittedly fairly simple. You have to sit down and listen to your patients, identify their needs and understand them. You must understand the nature of the problem and a patient’s perspective before you can fully address the issue. Good medicine involves building a relationship and following a well-thought-out plan, but it also involves a willingness to modify that plan as appropriate.

As a physician, I’m a doctor first while I work as a specialist in neurology. I have focused on headache and pain syndromes in recent years but continue to care for patients with a variety of neurologic conditions including stroke, traumatic brain injury, neuromusculoskeletal problems, neuro-degenerative diseases, pain syndromes, diseases of the central and peripheral nervous system as well as brain tumors.

I enjoy the challenge, and I really do love my patients. I feel fortunate to live in Hawaii and to have cared for our people here since 1993. I look forward to joining the collaborative team at Manakai on June 1. We will work together to prevent and treat migraine headaches in a most comprehensive fashion both to reduce pain and optimize quality of life. I am truly inspired by this opportunity.

David Kaminskas is a neurologist. He begins work in June as medical director of the Pacific Headache Center at Manakai o Malama Integrative Healthcare Group. Dr. Ira Zunin has turned over his column to Dr. Kaminskas this month. Zunin’s column appears the first Saturday of every month. Please submit your questions to info@manakaiomalama.com.