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July 13, 2020

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Finding migraine relief with botox

Injections help woman who has suffered from headaches for three decades

By , Columbian Health Reporter
4 Photos
Neurologist Gurjeet Singh injects Botox into Kari Carlson’s forehead as her husband, Keith Carlson, offers his support. Carlson receives 31 Botox injections every 12 weeks to manage her chronic migraines.
Neurologist Gurjeet Singh injects Botox into Kari Carlson’s forehead as her husband, Keith Carlson, offers his support. Carlson receives 31 Botox injections every 12 weeks to manage her chronic migraines. Photos by Ariane Kunze/The Columbian Photo Gallery

The migraines began in 1987. When one struck, Kari Carlson would see black spots and become nauseous. The searing pain would bring her to her knees.

Each migraine would last three to five days. She would have them at least once a month, usually about the same time as her menstrual cycle.

But about 10 years ago, the migraines changed. They became more frequent, sometimes daily, and the symptoms are different. Instead of seeing spots, Carlson, 53, sees double. The double-vision means Carlson can’t drive, can’t work, can’t function. Pain radiates across the her head. She often vomits. Each headache lingers, sometimes for days, until another migraine strikes.

For years, Carlson tried to manage her pain and chronic migraines with over-the-counter medication, mainly ibuprofen or Excedrin Migraine. Nothing gave her relief.

Doctors offered few solutions. Some prescribed preventive drugs; they never worked. Some recommended narcotic pain medication, which Carlson didn’t want. Others told her migraines were just going to be a part of her life.

Handheld device new tool to stop migraine pain

Legacy Medical Group-Neurology in Salmon Creek recently got a new tool for fighting migraine pain.

Earlier this month, Dr. Gurjeet Singh acquired a new device that stops migraines in just minutes. The gammaCore is a non-invasive vagus nerve stimulator.

The handheld device has electrode surfaces that are touched to the side of the neck. The device emits an electrical frequency that stimulates the nerve for two minutes. It's used on both sides of the neck and has been shown to stop headaches within five to 10 minutes of use, Singh said.

While Botox is used as a preventive treatment for migraines, gammaCore is used as an intervention to stop breakthrough headaches, he said.

The device was just recently approved by the Food and Drug Administration and isn't yet covered by insurance companies in the area. Without insurance coverage, the device costs nearly $500 per month to lease and use in-home.

In the meantime, Singh has the device for in-office patient use.

“It’s very discouraging as a patient,” Carlson said. “Nobody could fix me.”

But now, Carlson is finding relief from a somewhat unexpected source: Botox.

In July, in the midst of a particularly severe migraine, Keith Carlson drove his wife to the emergency department. Hospital staff suspected a stroke and ordered an MRI and other tests. Turns out, Carlson was having a severe, complicated migraine — the symptoms of which tend to mimic those of a stroke.

“When me and my husband came here, we thought I was dying,” Carlson said. “We thought I was doomed.”

Instead, Carlson met Dr. Gurjeet Singh, a neurologist at Legacy Medical Group-Neurology in Salmon Creek.

“He’s been my hero,” Carlson said.

Singh determined Carlson was a good candidate for Botox treatment. In late 2010, the Food and Drug Administration approved the use of Botox to treat chronic migraines — those with 15 or more headache days per month. Botox is approved only for those 18 to 70 years old — it’s considered an “off label” use, not covered by insurance, for other ages — who have tried at least two preventive migraine medications without relief.

Unlike some medications, Botox doesn’t have side effects, aside from the painful injections — as long as it’s administered by someone who knows how to properly inject the drug, Singh said.

The treatment requires 31 injections in the forehead, temples, back of the head and upper shoulders. The injections are administered every 12 weeks and essentially prevent migraines from occurring, Singh said.

“Nobody’s really sure how it works or why,” he said.

The theory is Botox relaxes the muscles and nerve endings that cause migraines, Singh said. Research has shown that 30 to 40 percent of patients find relief after the first round of injections, he said.

After the second round, Singh said, patients see more dramatic results. Research shows 60 to 70 percent of people find relief after the second set of injections. For Singh, many of his patients see their headaches stop completely.

Singh spent several months advocating for the treatment to Carlson’s insurance carrier before receiving approval. She received her first dose of Botox in December. Within two days, the headaches stopped. She didn’t have another headache for two months.

“I was having a headache every single day,” Carlson said. “I didn’t know how foggy my head was until I didn’t have any fog. I have a new brain.”

Carlson wasn’t stuck lying on the couch for days on end. She didn’t have to call in sick or leave work early. Her energy — and her spirits — were up. But after two months, the Botox began to wear off and the headaches returned.

Carlson recently received her second round of injections.

“I’m so excited,” she said. “I’m hoping it does last the whole three months because I can’t imagine seeing for three months.”

Singh is happy to see his patients, like Carlson, finally find relief. Far too many people, he said, minimize headaches and live with migraine pain.

“People give up hope,” Singh said. “There are so many treatment options out there. That’s the sad part.”