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Botox Migraine Treatment Questioned by Experts

A recent study shows that the drug's effect is not as substantial as initially desired.

The efficacy of Botox as a treatment for migraine headaches was called into question this week in an article in the Journal of the American Medical Association.

Approved for therapy of chronic migraine headaches in 2010 after a number of patients reported headache relief subsequent to Botox injection for wrinkles, the treatment had been the subject of multiple previous studies, and is a multimillion dollar health care expense on an annual basis. In the new study, authors reviewed the previous scientific literature and analyzed their combined results. 

Migraine headaches affect 15 percent of people in the United States. They are usually deep and throbbing in nature, and worsened by light, movement and straining. Although classically described as unilateral in nature, up to one-in-four people may have bilateral pain. Other symptoms may include nausea and vomiting, nasal stuffiness and teary eyes. About 20 percent of people experience a preceding “aura”, which may include flashing lights, zigzag lines or numbness. Certain factors may precipitate migraine headaches, including stress, lack of sleep and certain foods.

Once pain begins, treatment may be challenging, especially if delayed. Aspirin, acetaminophen, or non-steroidal medications are variably successful. If pain relievers do not work, one of a class of medications known as “triptans” are often used and are available as pills, nasal sprays or injections. These medications should be avoided in patients with known heart disease.

For patients with frequent attacks, preventive therapy is often tried -- that is the use of a medication to prevent migraines from happening at all. Beta blockers, antidepressant medications, anti-seizure medications and calcium channel blockers are examples of options in this class. However, this strategy requires the daily and regular administration of medications, which makes Botox injection (perhaps every three months) an attractive alternative.

Unfortunately, the recent article showed only a slight decrease in the number of migraine headaches per month, with the effect limited to patients who had attacks at least every other day; patients with 15 or more migraine attacks each month suffered, on the average, two less headaches each month while on Botox treatment.

Like all medications, Botox is associated with the potential for side effects. Dry eyes, drooping of the eyelids, influenza like symptoms and headache may be seen in up to 10 percent of patients. Because of this, therapy needs to be provided by a physician with experience and expertise in its administration.

It is important to note that while the study notes the average response to Botox, there are patients who report significant relief in their symptoms. So, if you are a frequent migraine sufferer (i.e. at least one every other day), speak to your primary care physician and see if a trial of Botox makes sense for you.

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