BOTOX

The exact mechanism by which BOTOX provide pain relief is not known but historically, it’s been thought to be involved in the inhibition of the release of Ach at the neuromuscular junction (Binder, 2002). Since BOTOX appears to have both chronic and acute relief of migraine pain and associated symptoms ( i.e. nausea, vomiting, photophobia, visual disturbances and phonobia), it seems that BOTOX may have an alternative mechanism of action with a different pathophysiological pathway than that related to muscle dysfunction. This mechanism may cause an effect that provides pain relief in excess of the reduction of inappropriate muscle contraction (Johnstone and Adler, 1998; Brin, 1998). Considerably, BOTOX is a safe therapy with self-limited adverse

2008 performed a study that assessed the efficacy of acupuncture in migraine prophylaxis (Alecrim-Andrade et al., 2008). Thirty- seven patients with migraines were enrolled in the study and the patients were divided into two groups in a randomized controlled trial. One group received 16 real acupuncture sessions over a period of three months while the other group received 16 sham acupuncture over the same time period (Alecrim-Andrade et al., 2008). In the first two months, real acupuncture group showed significant improvement compared with the sham acupuncture group (Alecrim-Andrade et al., 2008). Enthrallingly, the difference that existed between sham and real acupuncture groups disappeared in the third (last) month suggesting that with time, sham acupuncture gets to the efficacy level of real acupuncture. Another complementing study performed by Bäcker et al. 2008 investigated the influence of acupuncture on the autonomic system of migraineurs (Bäcker et al., 2008). Researchers monitored changes in heart rate variability during acupuncture treatment in thirty migraineurs. These migraineurs were allocated to two groups receiving either verum acupuncture (VA) or sham acupuncture (SA) treatment (Bäcker et al., 2008). The study revealed that in both VA and SA groups, there was at least 50% reduction of migraine attacks. In addition, the clinical responders exhibited a decrease of low-frequency power of heart rate variability in the course of the treatment. This effect was not observed in patients without clinical benefit (Bäcker et al., 2008). Although VA compared with SA induced a stronger decrease of high- frequency power, mode of acupuncture however, did not have an impact on clinical outcome (Bäcker et al.,