Cautiously optimistic about Botox

The last time I checked in about my progress with Botox I had only experienced one migraine. As migraines go, it was pretty bad just because it lasted so long and I didn’t have access to abortive medicine. I got through Christmas with only one minor attack on Christmas Eve and anther Christmas night. Both started up just as I was getting ready for bed and were barely strong enough to treat with more than an ice pack. Given the importance of being present with my family for holiday celebrations, I went ahead and took a triptan each night just to be sure I knocked it out.

Today was a very different experience. For forty years I have relied on the quality of the pain to guide my acute treatment choices. The speed at which the pain increased, where it was located,  and what made it worse — these were signs I could rely on to help me determine what treatment choice to make. I knew when I could start with just an ice pack and some Excedrin, or when a triptan was required, or even if I was going to need more aggressive measures. In the absence of any pain, I had nothing to guide me. Just after noon the symptoms started with strong phonophobia, so I grabbed my silicone earplugs to ease the discomfort. It wasn’t long before I was turning off lights and reaching for my sunglasses. Photophobia had begun. Then out of nowhere, I felt nausea creeping in.  I rarely get nausea and almost never vomit anymore because I have learned how to stop most attacks before they get that severe. Apparently this was not one of those times. Within minutes I was vomiting, despite pre-medicating with Phenergan.  It was a migraine all right, and a nasty one at that.

Botox completely blocked all the pain.

Another change I have noticed is that my weekly cluster attacks can now be aborted consistently with my homemade nasal spray. I don’t need Tiger Balm, energy drinks, or even oxygen.  Hopefully Botox had something to do with that change, too.

It’s only been 2 weeks. That’s just enough time for any placebo effect to wear off. The next six weeks will be a true test of Botox’s initial effectiveness. Historically, the last 2 weeks of December through the first 2 weeks of February are when I am at highest risk for intractable migraine and cluster attacks. One year I had 20 days straight of attacks and 2 ER visits.  If Botox can keep me functional into the New Year, then I will truly be impressed.

I know it’s not a cure. I also discovered that it really doesn’t stop the migraine attack — just my sensation of pain. When I shared this experience with my husband this evening, he asked if I would have been able to work with this type of attack. Unfortunately, the answer is “no.” I still couldn’t think straight. Sound and light were painful. Vomiting was no fun either. And ultimately I had to take a nap to sleep it off.