Migraine and other headache conditions are a common cause of pain. Migraine headaches are the leading cause of temporary disability in the work force. Fortunately, there are many medications that can be used to prevent and treat migraines.

The first therapeutic event which needs to happen is the correct diagnosis of migraine to be made. Patients can have multiple headache types. Headaches which are severe enough to limit activity and are associated with light and sound sensitivity with nausea and sometimes vomiting are most likely migraines. Migraines usually have a pulsating, heartbeat type pain – made worse by movement.

A common type of headache which can mimic migraine is occipital neuralgia. Occipital neuralgia starts at the base of the skull. There the occipital nerve exits the spine and runs up the back of the skull to the forehead. This nerve carries pain fibers. If it becomes irritated, due to trauma, “sleeping wrong” or just routine daily activities; occipital neuralgia headache occurs. The pain can be just as severe as a true migraine. The pain can be on one side, both sides or even isolated to the front of the head. Diagnosis of occipital neuralgia is made by gently pushing at the base of the skull, over the occipital nerve. If this reproduces the headache symptoms, the diagnosis of occipital neuralgia is made. The most effective treatment for occipital neuralgia is a simple injection in the upper neck in the region of the occipital nerve.

Botox was approved by the FDA in 2011 for treatment of intractable migraines. Botox migraine treatment is not for everyone. In order to have insurance or Medicare to pay for Botox, certain criteria must be met. These criteria include:

– 15 headache days a month
– Failed various migraine prevention medications
– AEDs
– Antidepressants
– Certain blood pressure medications
– muscle relaxants
– physical therapy
– migraines must be incapacitating causing missed work or school

All of these criteria must be met before insurance will authorize and pay for Botox therapy for migraines. Once approved, Botox for migraine is a simple, in-office procedure. For experienced migraine doctors, giving Botox for migraine takes about 20 minutes. Botox does not work immediately to relieve intractable migraines. Effects can be felt as soon as two weeks but maximum benefit is at 6 weeks after Botox treatment. Duration of pain relief can be from 6-8 weeks. With repeated Botox treatment for migraine headache, there is a cumulative benefit in many patients. The minimum time in between Botox treatments is 90 days.

For optimum migraine control, affected patients should be treated every 3-4 months. This results in the best migraine control. This in combination with oral medication migraine prevention therapy.

In conclusion, Botox is effective treatment for many headache patients with chronic, intractable migraines. Proper diagnosis and treatment must be given. For insurance to pay for Botox for migraine, specific criteria must be met. If you suffer from persistent, frequent headaches, call Sarasota Neurology today for an appointment. Start improving your quality of life today.


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Vertigo is one of the most common causes of dizziness. It is distinctly different from other types of dizziness. With vertigo, a patient feels a spinning or moving sensation. The room or floor can feel like it is moving or the patient may feel a spinning or off balance sensation. Vertigo can sometimes be associated with nausea or vomiting. If severe, walking can be affected with the patient having staggering or inability to walk.

Vertigo has many causes but the most common include head trauma, ear infection and Meniere’s disease. Vertigo can frequently occur spontaneously, without a cause, and this is called benign positional vertigo (BPV.) Temporary vertigo can be experienced after getting off an amusement park ride or going out boating (sea sickness.) Meniere’s disease is a condition of sudden episodes of severe vertigo associated with progressive hearing loss. Stroke is a relatively rare cause of dizziness.

The cause of benign positional vertigo is quite simple. In the inner ear, our balance center, are the semicircular canals. These canals contain fluid that moves when we move, stimulation motion sensitive hair-nerve cells. It is this mechanism that gives us balance and allows up to keep from falling. Inside the area that contains the semicircular canals are small calcium crystals. When one of these crystals breaks off from the wall of the labyrinth, they move into the semicircular canal. With changes in head position such as rolling over, getting out of bed, bending, looking up or looking suddenly to one side, the calcium crystal (canalith) moves, abnormally disturbing motion-sensitive hair cells. This is what gives the sensation of vertigo or feeling dizzy. The vertigo associated with BPV is usually short in duration. In more severe cases patients can be disabled. A condition known as labyrinthitis is a severe form of vertigo, caused by inflammation of the labyrith. It needs to be differentiated from stroke. A CT or MRI brain scan should be performed.

Treatment of vertigo consists mostly of medication control of symptoms. Meclizine is the standard drug used for symptomatic treatment of vertigo. It is safe, effective and nonhabit forming. The usual dose is 25 mg one to four times daily. Drowsiness is the major side effect. For patients who do not respond to meclizine, very low dose Valium (1 mg) can frequently be effective.

There is nonpharmaceutical treatment of vertigo. This requires the affected patient to do Epley Exercises 2-3 times daily. This has the effect of repositioning the calcium crystal and fatiguing vertigo response. This You Tube video has an excellent demonstration of these exercises. The American Academy of Neurology recently published guidelines for treatment of vertigo. The medical evidence is strongly in favor of physician administered canalith repositioning. This was the most effective treatment available.

In summary, most causes of vertigo are benign but the symptoms can be disabling. Sometimes it is important to rule out more serious causes of vertigo such as stroke or brain tumor. Affected individuals should seek out care from a neurologist or other physician familiar with the treatment of vertigo.


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