Tuesday, March 29, 2011

BOTOX for Migraine Headaches

BOTOX for Migraine Headaches:  Is it Effective?

Migraine headache is a disabling medical condition that affects 11 out of 100 people in the United States.  Majority of these patients are women (3 out of 4 people with migraine headaches.)  With the serendipitous discovery of BOTOX reducing the frequency of migraine headaches in women who underwent BOTOX treatment for their forehead wrinkles, the idea of using BOTOX to treat migraine headaches seem promising.  Does BOTOX really treat migraine headaches?  

Migraine Headache Symptoms
  • Throbbing pain on one or both sides of the head
  • Stiff neck
  • Visual hallucinations such as zigzag lines and flashing lights
  • Nausea and vomiting
  • Irritability 
  • Mood swings
  • An episode of migraine can last from 3 to 72 hours

    Photograph courtesy of Targetwoman.com
    Fast Facts about BOTOX for Chronic Migraine Headaches

    • BOTOX was approved by the FDA on October 2010 for the prevention of chronic migraine headaches for adults.
    • Chronic migraines are defined as migraine headaches that occur more than 15 days a month for more than four hours per day.
    • A study involving 1,384 adult patients revealed that patients who received BOTOX injections for migraine headaches experienced 7.8 and 9.2 fewer days of migraine than they had before the studies started. Those who received  placebo injections (sugar pill) experienced 6.4 and 6.9 fewer headache days.
    • Patients who received BOTOX for chronic migraine headaches experienced 107 and 134 fewer hours of headache, versus a reduction of 70 and 95 hours for those on placebo.
    • Patients were also found to have reduced consumption of migraine headache medications, such as sumatriptan, after BOTOX injection for chronic migraine headaches.
    • About 1% of patients who received BOTOX injection for chronic migraine headaches found that their migraine headaches worsened after treatment.
    • Most common side effect was transient cervical pain (neck pain) according to one study.
    Unfortunately, BOTOX is not the panacea for migraine headaches.  It can reduce the frequency of migraine headaches in patients who have chronic migraine, but does not completely cure it.  I recommend seeing your physician (especially a Neurologist) to determine if you have chronic migraine headaches, and to evaluate if you are a good candidate for BOTOX to treat this disabling medical condition.

    Emmanuel De La Cruz M.D.

    US FDA: FDA approves Botox to treat chronic migraine. October 15, 2010    www.fda.gov
    Cady et al.  A multi-center double-blind pilot comparison of onabotulinumtoxinA and topiramate for the prophylactic treatment of chronic migraine. Headache. 2011 Jan;51(1):21-32. pp1526-4610
    Diener et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial.  Cephalalgia. 2010 Jul;30(7):804-14
    Dodick, et al.   OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program.   Headache. 2010 Jun;50(6):921-36  
    Oterino, et al.  Experience with onabotulinumtoxinA (BOTOX) in chronic refractory migraine: focus on severe attacks. Journal of Headache Pain.  February 2011.(Epub Ahead of Print)  


    1. My wife suffers from Migraines and we have been considering this as an option. Is it safe?

    2. Yes, it is a safe procedure if performed by a trained neurologist or plastic surgeon. A Beverly Hills Facial Plastic Surgeon in the 1990s serendipitously discovered that Botox injection in patients with chronic migraines had a reduction of the frequency of their patients' migraine headaches. Botox injection for chronic migraine headache was then deemed safe after several clinical studies, and subsequently approved by the FDA.

    3. Do you file on the patients insurance for botox for migraines? Can you verify coverage before the patient has the procedure? I have documented migraines and am taking topamax 100 mg 2 times a day for them. They are controlled for the most part, I probably have 4 a month now but would rather try botox so I could quit taking the topamax. thanks

    4. Some insurance companies, unfortunately, does not cover BOTOX for migraines. It really depends on your plan.


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