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Botox for Migraines: Looking Good, Feeling Good?

June 29, 2005—A common procedure that reduces wrinkles may also help prevent frequent headaches, new findings suggest. Researchers found that giving a series of injections with Botox, already used by millions concerned about looking their best, could cut the incidence of severe migraines by more than half. Those who used Botox also had less need for over-the-counter pain medications when they did suffer a headache.

The results, which were presented at the American Headache Society meeting last week, have been criticized by some migraine experts. "There is no proof that Botox works," said Michael Welch, MD, a neurologist with the Rosalind Franklin University of Medicine and Science in Chicago.

He complained that the new results were based on a review of a previous trial that failed to show Botox could help prevent migraines overall. Finding that it works on a smaller group of patients in the same study is not considered reliable, he said. "We have to be very cautious."

Still, the latest news is bound to add to the strange fortunes of botulism toxin A, a purified food poison that has now become a runaway cosmetic hit as the main ingredient in Botox. The anti-wrinkle treatment was first approved for use against eye muscle disorders, and it has since been found to relieve everything from nerve problems to excess underarm sweat. The toxin quickly gained popularity with so-called "Botox parties," where plastic surgeons injected wrinkled volunteers in front of small gatherings of people who were considering the procedure.

Dual-Purpose Botox?
So far, Botox is not approved by the Food and Drug Administration (FDA) for migraines. Yet Stephen Silberstein, MD, director of the Headache Center at Thomas Jefferson University Hospital in Philadelphia said that the treatment could prove tempting for migraine sufferers who want to feel better and look younger.

"It's icing on the cake," he said.

Silberstein was part of the research group that reexamined 228 people who suffered from severe migraines. About half of the patients received a series of 10 to 25 Botox injections in their head, neck or shoulders every three months. The other half received saline injections.

After six months, Botox failed to show a reduction in migraine headaches compared to a placebo. But looking at patients who suffered more frequent attacks, Botox was linked to a 20 percent greater reduction in migraines, according to results presented at the headache meeting by David Dodick, MD, of the Mayo Clinic in Arizona.

The Botox group suffered an average of 14 migraines a month before the study. After receiving treatment, headaches dropped to six a month. In the saline group, patients went from nearly 13 migraines a month to about eight.

Another analysis, led by Frederick Freitag, DO, of the Diamond Headache Clinic in Chicago, found that Botox could reduce the need for pain medication. Patients who took Botox reduced their use of ibuprofen and other pain relievers by 60 percent compared to 35 percent with saline injections.

Botox in Practice
Freitag, who has treated his migraine patients with Botox for more than a decade, said that people who have four to eight headaches a month generally don't respond to this therapy, but those with more challenging headaches might. There are several treatments that are used to prevent migraines, including anticonvulsants, blood pressure medications and anti-depressants.

The newest treatment is Topamax, which was specifically approved by the FDA for migraine prevention. Freitag said that Botox seems to have the same effect as antidepressants in relieving headache frequency. "About one third of patients will show some benefit," he said.

Botox, however, can also make your face feel frozen, and those who hope to have fewer age lines in addition to fewer headaches may come away disappointed. The areas of the body that doctors need to inject Botox is often different for migraines than for cosmetic reasons. "They rarely overlap," Freitag said. "Patients will look the same."