Journey to Botox

For over half my life I have lived with this disease. My first memory of having head pain was at 8 years old. It wasn’t until, 1998, when I was 18 years old that I was official diagnosed with migraine. Like so many stories that I have read, this disease was not taken seriously by medical profession. It was brushed off as “stress” and I was put on a regiment of antidepressants and anxiety medication.

I am now forty years old, and during my journey with this disease, I have tried just about everything to manage my attack. In 2014, at the age of thirty-four; my disease went from a diagnosis of “episodic” to “chronic”. The year 2014 marks the time when I was involved in a minor fender bender, which set off a series of cervical spine surgeries. I went from being a vivacious, enthusiastic, go-getter–with an extremely active lifestyle , working full time in a career that I was passionate about and finishing up my degree for my Doctoral program.

At the beginning of this “Chronic Migraine” journey, I was living in constant excruciating daily pain. I can only describe this pain as feeling like I had gasoline burning in my head, neck and upper back 24/7. The pain crippled me; causing me unable to leave bed for days on end. The “go, go, go” life that I had once had came to a screeching halt. I became deeply depressed. It was during this time that I was forced to take a break from my career and educational endeavors to focus on solely on my health.

If one word was used to describe this season of my life it would be DESPERATE! It was during this time that I was introduced to the notion of a multidisciplinarian approach to my disease including western and eastern medicine. The therapies that tried were biofeedback training, cognitive behavioral therapy, acupuncture, massage therapy, physical therapy, taking a regiment of Chinese herbs, vitamins, and meditation—and this was all done IN addition to being on the Russian roulette of the “standard” western medical protocol for this disease–this was comprised of the trial of MULTIPLE medications, nerve blocks, ultrasound guided nerve blocks and trigger point injections, occipital nerve blocks, medial branch blocks, and three cervical spine surgeries, including an occipital nerve decompression procedure. I was put through the wringer of western and eastern medical treatments for Chronic Migraine. My Neurologist, who by the way was an ABSOLUTE GEM; was left wringing his hands as to what else I could possible try to obtain a level of control of this disease. He and I discussed many different options including being put on the waiting list at the Mayo Clinic and a variety of a Headache Specialist across the Western half of the United States. My doctor wanted me DESPERATELY to try Botox but, unfortunately, my insurance at the time REFUSED to cover Botox. So, it appeared we were at an in pass–I had basically decided that this was going to be the rest of my life.

Here we are at present time–I have endured countless rounds of fertility treatments that ultimately led to IVF (In Vitro Fertilization) which, blessed me with a beautiful son. Additionally, I was doubly blessed with; a Headache Specialist who was willing to try ANYTHING to help to get my attacks manageable. During the past 3 years, I have tried a 10 day hospital in-patient program for Chronic Migraine; been on several new medication protocols and have tried a variety of treatment options. BUT the BIGGEST blessing of them all–my new insurance COVERS Botox.

So here I am, eleven rounds of Botox under my belt and there have been many things I have learned over the past two years. So here is my list of things that I WISHED I had known

Things That I Wished I had Known About Botox for Migraine

• Get Out Your Boxing Gloves: Be prepared for a fight with your insurance company– Just because your Doctor signs off on Botox DOES NOT mean its a done deal. I spent countless hours on the phone with insurance. Including several DENIAL letters, of which, I was forced to provide documentation (medical records), a personal statement and other documentation submitted to the insurance company. I wish I could say this was an isolated experience–but this is something that I have had to fight EVERY TIME I am scheduled for Botox. Sometimes, this process will take WEEKS or even MONTHS, which inevitably delays Botox.

• Botox Does Not Have the Same Efficacy Every Time.- I learned this the hard way. After receiving a full 4 rounds of Botox (all of which helped to some degree), I received a round of Botox that WAS NOT as effective. At week 6, my doctor (who had been administering nerve blocks to help with the pain), requested blood work, which included a Botox antibody test–to ensure that I was not becoming immune to that particular Botox strand. (which can back negative by the way). It took approximately 8 weeks before I begin to notice any changes in the intensity of attacks. BUT, overall, this round of Botox DID not work as well. Being of an inquisitive nature, I asked my doctor WHY it had not been as effective as previous treatments. His conclusion was that perhaps the medication when shipped in a COLD environment could have been exposed to some warmer temperature, which could have disrupted the molecular composition of the medication. Apparently Botox, is incredibly sensitive to temperature changes. Somy recommendation is if you have noticed that your medication was not kept quite as cold as you think is appropriate; to contact your pharmacy and see if they are willing to reship the product (JUST A SUGGESTION)!

• Botox DOES NOT Mean That You Will Become Attack Free– Please remember I am speaking from a “Chronic Migraine” perspective. Yes the infomercials depict individuals frocling through a field of flowers after receiving a treatment. But, for me, THIS IS NOT THE CASE. Yes, I have noticed decreased neck pain, intensity of attacks and shortened attack time–BUT receiving Botox DOES not mean you will be pain free! (AGAIN, this is JUST my PERSPECTIVE–EVERYONE is different in their response to Botox).

• .It Takes TIME– Buckle up because it will take time for the medication to kick in. For me it can take upwards of 3 weeks after the administration of Botox for evidence of a decrease in attack frequency, duration and intensity. Often times this GRADUALLY takes effect. My best indicator that its taking effect: my eyebrows can’t move like they used to! 🙂

• It (CANNOT) Last as Long as You Would Think- Let me start with this disclaimer: EVERYONE IS DIFFERENT! But my experience with Botox, is when it works, it works WELL. But when it begins to wear off–buckle up its “Attack City”. The other thing is they, and when I say “they” I’m referring to the insurance company, has some sort of algorithm which came up with TWELVE weeks as the magic number for the AVERAGE person to receive their next treatment of Botox. My experience is that my Botox begins to wear off around week ten. Which means I have two weeks of intense attacks —-followed by 2-3 weeks waiting for the medication to began working. So, all together I am looking at approximately 5 weeks of absolute hell. During this time, I hold fast to the hope that it will start working any time; give myself LOTS of grace, rest and self-care. AGAIN, this is MY experience. I will say that I have spoke with other individual with Chronic Migraine and this is their experience as well. Talk with your doctor!

• There is a CHANCE it may NOT Work Your 1st Time–To be honest, this was something that I was 100% unprepared for. NO ONE explained to me that on the AVERAGE, the first or even second time of administration results in little or no difference in attacks. When the medication is presented it is shown the “GOLDEN TICKET” to your treatment plan—it was presented as THE thing that would CHANGE my life. But, I am going to be absolutely authentic with you…..YES it has changed my life—but it took TIME—its been over TWO years since I received my first round of Botox and within the past 6 months is the first time I have seen SIGNIFICANT changes in the frequency, duration and intensity. But you have to remember I started with the daily “gasoline in my head” level pain. So this MAY NOT be the result that YOU experience. I wouldn’t say you need to prepare for the WORST possible scenario, I recommend that you go with an open mind and the expectation that this COULD take some time to elicit results. Remember Rome was NOT built in ONE day—Good things take TIME!

• MOST Insurances WILL NOT Cover Botox any sooner than Twelve Weeks Between Each Session– If you find yourself in the similar place that am; that your botox wears off WAY before twelve weeks. You will find that the majority of insurance companies DO NOT want to pay for you to have Botox and sooner than the magical twelve week number. AGAIN this may work out FANTASTIC for you—but if you are in my situation you need to be prepared to have to wait for the twelve weeks between administering. ONE solution my doctor and I have come up with is to do nerve blocks ever few weeks, especially during the “waiting period”. This seems to help get through the “hump” until the medication begins to set in. TALK WITH YOUR DOCTOR for a PLAN that fits YOUR situation!

• Botox Savings Program--If you do not have insurance that covers Botox–you are IN LUCK–there is a Botox Savings Program which you an enroll in! It is comprised of some basic questions accompanied with some documentation. I did not learn about this program until this year, and feel like it IS NOT widely publicized. Even if you do have insurance and have to pay a RIDICULOUS copay (like me)–this program can help! Take and look!

Final Thoughts and DISCLAIMER

I would like to reiterate that I AM NOT A MEDICAL DOCTOR. This is simply an overview of the issues that I have encountered with Botox. All in all–BOTOX has changed my life. Even for the short window of time that I have lowered pain days when it is working at 100%–I no longer have the “gasoline in the head” type pain and the duration and intensity of attacks has decreased exponentially. Yes I am still classified as someone who lives with “Chronic Migraine”. But now I have found a protocol that WORKS for me. I ENCOURAGE you to discuss with your doctor what treatment plan is best for you. This list was merely a reflection of MY experience living with Chronic Migraine and the treatment options I have tried. AGAIN SPEAK WITH YOU DOCTOR.

I have been a suffer of migraine since I was a child and having turned chronic six years ago, I have spent countless hours researching potential factors that could be playing into this neurologic disorder.  Several years ago, I learned from my neurologists/headache specialist that migraine is actually a genetic disorder. Which means it is written on your DNA.  That doesn’t mean that all individuals with “migraine” written on their DNA are plagued with chronic migraine—it simply means that having it written on our DNA makes us PREDISPOSITIONED to be more susceptible for this condition.  There is more in depth information about genetics and migraine found at the American Migraine Foundation’s website.

But having learned this information, it made me really think—what other issues inside my body could be a factor in chronic migraine.  I am lucky and have an amazing headache specialists who is constantly trying to think outside the box.  He is a true gem, one that is not typically found in the sea of doctors that treat this disease.  I was recently chatting with my doctor and he suggested that mitochondrial dysfunction could be a potential factor in migraine.  I found this fascinating and thus have taken a much deeper dive into the scientific research that has been conducted on this topic.  The function of this piece is to introduce the basic ideas and to share resources with the migraine community—so that you too can be introduced to this research. 

So, buckle up to “NERD OUT” on cellular energy production! Disclaimer—I am by all means NOT a medical doctor NOR am I a scientific researcher.  I am simply a chronic migraine patient who is searching for non-pharmacological ways to improve my quality of life! 

Some research to ponder—according to study that was conducted in 2013 entitled Mitochondrial Dysfunction in Migraine, “In the 1980s, scientists first hypothesized a connection between migraine and mitochondrial (mt) disorders. More recent studies have suggested that at least some subtypes of migraine may be related to a mt defect” (Yorns & Hardison).  Moreover, there has been further research which indicates that:

“migraine is caused by mitochondrial dysfunction: impaired production of ATP from mitochondria. The best treatments for migraine are the treatments that improve mitochondrial function. In migraine, the failure of mitochondrial performance is endogenous: coming from within. Very importantly, inflammation can cause mitochondrial impairment, and mitochondrial impairment can cause inflammation.  However, the combination of inflammation with mitochondrial impairment is particularly devastating for the nervous system, strongly promoting pain, “sensitization”, migraine and seizure as well as neurodegeneration. Doctors are now realizing: To effectively treat these chronic pain conditions, we have to improve the patients’ nutritional status, and we have to specifically improve mitochondrial performance” (Vasquez, 2016).

So, I am sure you are sitting there asking yourself—OK SO how can I increase the function of a “potential” mitochondrial dysfunction??  

My doctor explained it to me in using non scientific terms (THANK GOODNESS—I told you he was a GOOD one!); and basically, there is a WAY to increase cellular function through increasing the functionality of the Pyruvate in your cells. Pyruvate is essentially one of the key pieces to help a cell function properly.  So, how do you “help” the Pyruvate in your cells to function more effectively?  Well, my doctor sent me to a website that allows you to purchase a direct derivate of Pyruvate called Pyrucet.  This derivative of Pyruvate is applied to my forearms once a day—I take 20 drops.  Since starting this I have noticed a significant increase in my energy, and feel as if the medications that I am on to help manage my migraine attacks are working more effectively.  I am in NO way endorsing that you run out and purchase this product, but rather want to share with the community another option to research and to discuss with your doctor.

Below are some links to some scientific articles, websites and other resources that I felt would help to enhance this information.  Take a look! This could be yet another way to fight the battle with chronic migraine!

• Mitochondrial dysfunction in migraine– Yorns & Hardison (2013)

• Mitochondrial dysfunction and migraine: evidence and hypotheses

• Energy failure (mitochondrial dysfunction) contributes to chronic pain, migraine- Dr. Alex Vasquez (2016)

• Definitions of Cellular and Role of Pyruvate in the Process
• Where to Purchase Pyrucet

DISCLAIMER—Discuss ALL medical treatments with YOUR doctor. I am NOT a Physician. This document was proofread and fact checked by my Headache Specialist prior to publishing.

The first time I had a hemiplegic migraine attack, I was 39 years old. I thought I was having a panic attack or a stroke when the attack first hit me early on a weekday morning. My right leg and arm went completely numb, I was carrying my son at the time so I sat him down in a safe area and laid down on the floor of our kitchen completely paralyzed on my right side. My son stood at the baby gate watching me lay on the floor as I tried to tell him, “Momma is ok” and call for my husband at the same time. You could see the shear fear in my baby boy’s eyes. Thankfully, my husband was running late for work that day and was still home. He scooped me up off the floor and on to the couch and made sure I was ok. After about 30 mins– the attack passed, and the weakness on the right side of my body stopped. Again, I thought this was a panic attack so didn’t really think much more about it until I started doing a little deep Google diving and found that there is in fact a type of migraine that mimics a stroke; it is called a hemiplegic migraine.

What is Hemiplegic Migraine

The American Migraine Foundation defines a hemiplegic migraine as, ” a rare form of migraine where people experience weakness on one side of their body (hemiplegia) in addition to the migraine headache attack. The weakness is a form of migraine aura and occurs with other forms of typical migraine aura like changes in vision, speech or sensation”.

The symptoms of hemiplegic migraine are as follows:

• Motor weakness on one side of the body (Hemiplegia)
• Headache
• Other typical aura symptoms – vision changes (sparkles, shimmers, visual field defects), numbness, tingling, trouble speaking
• Fever
• Impaired consciousness ranging from confusion to profound coma
• Ataxia (defective muscle coordination)
• Nausea and/or vomiting
• Phonophobia (increased sensitivity to sound) and/or photophobia (increased sensitivity to light)

The symptoms can last for hours to days, or rarely weeks, but most resolve completely.

In MOST cases of hemiplegic migraine, it presents when the patient is a child. I am a rare case in that it presented much later in life. Although when I think back on all the years I have lived with this neurological disease, I can remember points where I had weakness and “stroke like” feelings on side of my body–so it is possible I had it as a child but didn’t recognize the symptoms as being alarming until I have become much more educated on this debilitating neurologic disease.

Hemplegic migraine, like general migraine disorder; are linked to genetics. According to the AMF, “hemiplegic migraine is divided into Familial hemiplegic migraine (runs in the family) or Sporadic hemiplegic migraine (happens only in one individual). This is a very rare migraine type so if you ever experience new or never-evaluated weakness with your headache, you should seek immediate medical evaluation and not assume you have hemiplegic migraine. Both familial and sporadic hemiplegic migraines often begin in childhood. Diagnosing hemiplegic migraine can be difficult, as the symptoms can mimic stroke, seizures or other conditions. A full neurological work up, including obtaining imaging of the brain and vessels in the head, and careful review of medical history and symptoms are necessary to rule out other causes and confirm a diagnosis of hemiplegic migraine. Family medical history is especially helpful in diagnosing familial hemiplegic migraine”.

Living with Hemiplegic and Chronic Migraine

I am now 40 years old and have chronic migraine in addition to hemiplegic. I have lived with migraine attacks since I was 10 years old; but was not formally diagnosed until I was 18 years old. For, many years my migraine attacks presented with a visual aura in one eye, and head pain would follow within 1-3 hours. I was able to take a triptan such as, Imitrex, go to sleep and the attack would end. Approximately six years ago, I was in a minor car accident/fender bender, which turned my attacks from “occasional” to “chronic”. In the past six years, I have had three spinal surgeries to correct herniated discs in my spine (which they believe happened in the car accident). After the birth of my son in 2017, my attacks that were already chronic spiraled into making me bedridden. I was unable to care for my son the first year of his life. In 2019, I was admitted to an intensive migraine treatment program in Michigan, which led to the diagnosis of a Spinal Fluid Leak—I had a blood patch epidural to correct the leak in my spinal fluid. In the time since attending the program in Michigan, I have been slowly finding my path to what my life looks like living with Chronic Migraine. To say I was utterly SHOCKED with a new diagnosis of Hemiplegic Migraine is an understatement! My doctor ordered several tests and blood work to finally conclude that I was in fact having hemiplegic migraine attacks.

What I have found with my hemiplegic attacks are that they typically proceed an INTENSE head pain attack, nausea, dizziness and extreme light and sound sensitivity. The longest attack I have had was almost a week in entirety. The hemiplegic attacks typically occur when I am in a “Botox Letdown“, or an extremely stressful situation.

As far as treatment, my doctor has put me on a calcium channel blocker (Amlodipine–Norvasc). This treatment coupled with Botox every 12 weeks, daily maintenance medications and monthly Ajovy has seemed to help. But honestly, now that I am AWARE of what is happening to me; I have found that I just need to get to a safe place and ride the attack out. It has been INCREDIBLY scary having an attack while caring for my son, who is 2.5 years old. On the days when I do not have help at home from my husband—I will try to plan very low energy activities with my son like coloring, playdoh or painting. On the occasion it has gotten so severe that I am unable to use my arm or leg from the temporary paralysis, I have called a baby sitter or my husband has come home from work. The head pain attack that follows usually presents within 1-3 hours, and can last up to 4 days. During that time, I still experience weakness in my arm/leg accompanied with tingling and numbness, nausea, dizziness and noise/light sensitivity.

If you believe you have had/or are having hemiplegic attacks, I would encourage you to speak to your neurologists or headache specialists. They can perform the proper tests for a diagnosis. Having this diagnosis, in addition to having chronic migraine is challenging. But, for me, it has motivated me to be more vocal, educate and advocate for all forms of this neurological disease. There is such a huge misconception in our society surrounding migraine. As an advocate, I hope to educate the general public, and if I can help ONE individual then I am happy.

As a chronic migraine sufferer, finding another tool to add to your toolbox is always valuable. I discovered Gua Sha while receiving weekly accupuncture to try to settle my nervous system and get my migraine attacks under control. One thing that was noted was that my neck and back muscles were incredibly tight–I’m fairly sure my acupuncturists used the word “concrete” to describe my upper back and neck muscles. She suggested we give Gua Sha a try to help loosen the muscles. Once I did it a few times I was HOOKED. I had noticeable differences in my overall muscle tightness and discomfort which was perpetuating the migraine attack cycle.

What is Gua Sha?!!

So what is Gua Sha?! Well its a therapeutic, healing technique that has its roots in East Asian medicine. According to Dr. Sheel Desai Solomon, a board-certified Raleigh-Durham North Carolina dermatologist; “Gua” means scrape, and ‘Sha’ means sand,” in an article from Good Housekeeping , “Dr Solomon was noted saying that “it is a treatment that involves scraping a flat jade or rose quartz stone over the skin in upward strokes to relax stiff muscles and promote tissue drainage”. Furthermore, it has been noted to treat muscle aches, pain and tension.

My Experience

When doing proper technique of Gua Sha–the tool is rubbed agains the skin in long strokes applying enough pressure that may (or will) cause minor bruising. This article here; from Medical News Today, provides a great comprehensive overview at Gua Sha as a treatment tool including any medical concerns with using this as a form of treatment.

In my experience , I have been utilizing my Gua Sha tool on my face as a little gentle massage after I do my morning and nighttime skin routine, but I primarily use it on my shoulders, temples and neck muscles during an attack to help relax the muscles and promote blood flow in those areas.

What to Expect:

The first time I had the technique done, my skin was bruised for several days–it was not painful while being done but my skin was a bit sore to the touch for a few days following. Your skin should become a little pink/red while performing the technique, and it may turn into some bruising if any capilaries are broken. For me this technique has significantly helped my neck/upper back and shoulder muscle tension, and has been a great tool for me to keep the tightness under control.

On a typical day, I will do 2 treatments of my neck and shoulder area–usually once in the morning and again in the evening. If I am in an active attack, I may do upwards of 4 sessions to help keep my muscles loose—BONUS it feels like a nice gentle massage on those sore, painful areas that become activated during attacks.

What you need to perform Gua Sha:

1. Gua Sha tool or even a simple spoon will work!
2. Lotion or a gentle/non scented oil (I use coconut oil) to help move the tool across your skin.

Some of my favorite “How to” Videos for Reference:

1. Gua Sha on Back and Shoulders
2. How to do Gua Sha to Yourself
3. Breaking up muscle knots with Gua Sha
4. Gua Sha on Neck (MY FAVORITE)!
5. More Gua Sha on Neck

**Please check with YOUR doctor before trying any new treatments—this is only my experience and opinion of using this form of treatment in my migraine attacks.

If you are new to Botox, as I was this past year; I learned a few things about the medication that I thought would be helpful to share with my fellow chronic community.

• Either it works GREAT for you or it doesn’t! (Common theme amongst migraine treatments)
• Its EXPENSIVE and insurance will fight you to the death to not cover it!
• The botox injections themself, are a little painful, but the migraine I get AFTERWARDS is THE WORST–
• For some individuals, such as myself, botox begins to stop working around week 9–insurance will not cover you for your next treatment till week 12—for three weeks you are in migraine HELL.
• If the medication works for you (yeah!); over time it SHOULD help you MORE as it builds up in your body.
• The letdown weeks are horrid–I HAD NO IDEA that this was going to happen–for three straight weeks I was in an awful migraine attack cycle that could not be broken. But my doctor and I “may” have found a solution for that—I’ll keep you posted!

The elusive “Botox Letdown”–was not something that was covered or discussed with me prior to beginning the treatment. If you are new, or are considering this as a treatment option; I would encourage you to discuss this with your doctor!

Prior to moving to North Carolina, our insurance in Oregon REFUSED to cover botox as a viable option for migraine treatment (totally asinine in my opinion)! But, when we moved to North Carolina I discovered that IT was covered by our insurance company (with strings attached OF COURSE). My new doctor believed I would be an excellent candidate for it so after months of paperwork and bickering with insurance I was on my way to trying out a new tool.

MY EXPERIENCE

My first round went awful, I was in such a bad state from the unknown spinal leak that nothing you threw at my body at that point was going to help it until the leak was fixed.

The second round went ok..seemed to help some but took FOREVER to kick in..I was basically on week 9 before I began seeing any noticeable differences in attacks. Plus, I had just been discharged from the inpatient program m, So my body was in a whirlwind of WTH shock—needing time to heal.

When I went to get my third round—insurance all the sudden denied me—which ensued a 4 month battle of obtaining approval. At this point, I was considering driving to Canada or Mexico for the drug. I was feeling DESPERATE–which is a terrible feeling when in intense pain. IT. WAS.BAD! BUT, I had this tug at my heart that told me to keep trying—-so I pushed forward.

Finally, insurance approved me for my third round, but at this point it was as if I had come back to square one; it had been over 6 months since my last treatment. My neck and shoulder muscles were like concrete…tight, achy and painful.

But being feeling as if I should give this a few more tries, I had my fourth treatment in Summer of 2019–it seemed to help—it did take a few weeks but I began noticing attacks where shorter and less intense—a win in my book! Progress!

As time crept closer to my October treatment..I began to notice that my neck and shoulders at about week 8-9 started having “novocaine-like thaw out feeling”. Attacks started becoming more frequent and by the time I got to week 12 for my 5th round of Botox my body as in full attack mode—and had been that way for several weeks.

After a chat with my doctor we decided to add in a nerve block at week 8-9 to see if that would help extend the effectiveness of Botox—because it’s clear it’s working just need it closer together than 12 weeks—but guess what insurance is won’t cover it (SHOCKING)!

I had my 6th round of Botox in January 2020 (nothing like meeting your deductible RIGHT at the beginning of the new year!). Overall it went very well–Im actually began to notice the small differences in my attack frequency and duration.

I will go for my 7th round of Botox on April 23rd and I have been experiencing the dreaded “letdown” for weeks now–My last round I had nerve blocks done at 4 weeks out from my Botox date and it did seem to help a little bit, but with the Corona Pandemic–this was not an option for me this round. So I have just been muscling through the attacks of the “letdown”.

I’ve put together a list of the top 5 symptoms I’ve noticed when the Botox began swearing off (listed below), as well as how I try to manage these attacks while I wait for my Botox appt. I recognize that everyone’s situations are different—but felt that a list of symptoms could be helpful for someone like me who is a bit of a newbie to Botox!

My 5 symptoms of “Botox Letdown” and Tips on How I Try to Ease Them!

1). My temples become sensitive to touch– I find that they are especially sensitive during an attack. I have found that using my amethyst roller over these areas helps to relieve the pain, as does ice packs and a scalp brush that I use to massage my head and temples!

2). “Thawing out” feeling in occipital ridge area (at base of skull) —If you have ever had dental work and had Novocain it feels similar to this..but much slower and gradual—over several weeks. I have found that laying on my Pranamat (Accupressure mat) twice a day and laying on ice several times a day helps with this.

3). Attacks are worsened in intensity and duration– I find that as I grow closer to the Botox date my attacks are much worse. One way I try to combat this is take medication or rest AS soon as I feel an attack starting, and giving myself LOTS of GRACE during this “letdown” time.

4). Auras increase/hemiplegic attacks increase– during first several weeks after botox–all my auras seem to disappear. BUT as we creep closer to the 12 week mark and time for next round of treatment–I find that I have visual auras, tingling head and hemiplegic attacks (which are TERRIFYING). Stopping auras and hemiplegic attacks are nearly impossible- so again, I try to give myself LOTS of grace and not push myself during the “letdown” period.

5). Overall more tightness and achy in neck and shoulders (my problem areas)– Trying to stay ahead of neck and shoulder tension is always a fighting battle for me with attacks. During the time of the “letdown” I will be especially vigilant about foam rolling, stretching and using my acupressure mat. Epsom salt, magnesium flake and baking soda baths a few times a week also help with this!