A New Approach to Botox

My recent trip to urgent care for my muscle spasm yielded a very interesting conversation with a fellow migraineur. The doctor who was working at the time happened to be a D.O. who used to have frequent migraines. A quick look at my history revealed my status as a chronic migraineur and so she wanted to tell me about how Botox significantly reduced her migraines.

I explained that I had tried it before and it hadn't been effective. Honestly, I just wasn't interested in having a conversation about it. I was there for my spasm and the matter is quite complicated. But since she's a doctor I heard her out and I'm glad that I did. 

Apparently she had gone to a plastic surgeon long before Botox was being used for migraines and asked to get injections in her specific trigger points. She had discovered on her own that she was able to stop a migraine if she caught it early with an injection of lidocaine into the painful spot where it seemed to manifest from. This gave her the idea to seek out Botox injections in those points for a more long term solution. And it worked.

So instead of getting a prescribed number of injections in prescribed locations she only gets them in her specific trigger points. She emphasized that it has to be given in the exact right spot and she says that as the patient you really know when the doctor is in the right spot because it's pretty painful. She has been doing this regularly for many years and has had continued and consistent positive results.

I am fascinated by this notion. Doctors have been attacking trigger points with various methods as treatment for many years. There are nerve blocks, nerve decompression, topical ointments, acupuncture, acupressure, nerve stimulators, etc. Even traditional Botox as treatment for migraines is centers around these areas. I've heard so many stories from people who have tried Botox with such varied results. Sometimes it works for a while and then stops, or responds differently to each new round and I have to wonder what makes up that difference. I would think the same person, getting the same injections, from the same doctor should get consistent results.

This conversation got me wondering if the difference is that sometimes those injections are better placed than other times. If the doctor is injecting into a prescribed area that isn't relevant to your migraines perhaps it has no chance to work. If the doctor sometimes happens upon the right point that might produce better results. If a precise location is really that important, that could partly explain why experiences can be so varied despite other consistent variables. 

This method has been very effective for this doctor, which certainly doesn't mean it will work for me or you but I think it's worth exploring.

I still have questions. I don't know if my insurance will cover an office visit with this plastic surgeon or if they will cover Botox injections done by him in an unconventional manner. I don't know what it would cost if they don't. I would like to talk with a migraine specialist about this. And I'm super curious what you guys think of it. What do you think?

It Shouldn't be this Hard

So I never heard back from my primary care doc. I called her on Monday (day 5 of this muscle spasm) and asked if she might be able to spend in a script to help me because I wasn't able to drive. She didn't bother getting back to me so on Tuesday morning hubby had to go into work late so he could take me to urgent care.

I called the doctor in pain and with almost no range of motion in my head/neck area. She couldn't even bother calling me back. I wouldn't have minded at all if she wasn't comfortable sending in a prescription without seeing me. That is a perfectly acceptable response. But no response! No response is unacceptable!

I got what I needed from the urgent care doctor but she wanted me to follow up with my PCP if I don't feel better in a few days. Two days later and I'm not sure that my muscles are actually letting go. Between the muscle relaxers and Thermacare heat wraps I'm doing okay during the day but overnight the meds wear off and I'm in rough shape by morning. The very last thing I ever want to do is go back to that damn PCP.

The doc and her office staff have proved to be completely useless at every turn. But the way they have handled this situation makes me so angry. Today I received an email from Optum Rx informing me that my order is in the mail. I didn't call for a refill nor did I see or talk to my doctor so I have no idea what is on it's way. When I called Optum to find out I learned that my PCP went ahead and sent in a prescription for a muscle relaxer.

She didn't bother to call me. She didn't bother to use her brain. Common sense should have told her that it would take at least a week for me to receive the muscle relaxer from Optum Rx because they would need time to process and then send it in the mail. I obviously needed this right away so she should have sent it to the local pharmacy I have listed in my chart. AND I SHOULD HAVE BEEN INFORMED OF WHAT WAS HAPPENING!!

I'm so sick of being treated like I am not a part of this. I'm sick of all the mistakes! I'm sick of constantly trying to fix their fuck ups! I'm sick of not being able to talk directly with my doctor unless I come in and pay! I'm sick of not being treated with common decency and respect! I'm so sick of this broken system!

I wish I didn't need all these idiots who stands between me and access to the medications I need. Why are so many of them idiots?!?!?!? Why is it so hard to find a competent doctor with competent staff? It shouldn't be this hard.

Muscle Spasm, Migraines and Fibromyalgia

I'm now 5 days into a fairly severe muscle spasm. My neck and upper back started to spasm this past Thursday. Despite resting it, using the heating pad and taking my usual daily dose of muscle relaxant, the pain and stiffness has only gotten worse.

Muscle spasms are a regular part of my life. They have been for a very long time. What's unusual and noteworthy about this one is that it isn't resolving and it covers a fairly large area. I had one like this right around the time my migraines were starting to increase in frequency.

A little more than a year later my migraines were daily (constant). About 6 months after that, the neurologist I was being treated by in North Carolina put me on a daily dose of bachlofen (muscle relaxer). The idea being that if I could calm down the muscle tension in my neck/shoulders/upper back area that would prevent my muscle tension from retriggering another migraine before it has a chance to resolve.

Obviously this isn't a migraine treatment but it absolutely did reduce my daily migraine down to an average of 18 per month.
Perhaps it was actually treating a component of my fibromyalgia (I didn't even know I had at the time) and by doing so it helped with my migraines. Either way, I've taken 30mg of bachlofen every night for the last 10 years. Now I'm beginning to wonder if my body has grown so accustomed to it that it no longer is as effective as it used to be.

When I look at the big picture of my migraines and fibromyalgia I can't help but notice there are several components out of whack. Perhaps it's time to seek out a local migraine specialist. I would prefer to continue to see my specialist at the Mayo Clinic but considering I'm facing a number of questions I think it would be better if I could find someone local. Wouldn't hurt to give it a try.

Meanwhile, I have my fingers crossed that my PCP will call in a prescription to help me get on top of this present spasm. The range of motion in my neck is so bad that driving is not an option.