Botox for migraine headachesWhat is Botox?
Botox (botulinum toxin A) is manufactured by Allergan. The toxin is one of many that are produced from the bacterium Clostridium botulinum. If you eat something that has been contaminated by this bacterium, you ingest the toxins they produce and you are at risk for getting Botulism. Botulism is essentially paralysis of many parts of the body. This paralysis can affect your breathing, eye movements, swallowing ability, and the strength of all your skeletal muscles. The toxin causes paralysis by interfering with the connection between nerves and muscles. The nerves are thereby disconnected (chemically and temporarily)from muscles. Botulinum toxin A is very safe, since it is injected in controlled amounts, into muscles, under the skin, or into certain glands, at the locations desired. It is used to treat a wide variety of conditions such as muscle spasticity, cervical dystonia, hemifacial spasm, or excessive sweating. How might it work for migraine?It is not clear how botulinum toxin can help with migraines. There is speculation that it relaxes head or neck muscles and in this way, reduces their soreness, thereby eliminating a potential migraine trigger. Alternatively, there is speculation that the toxin directly interferes with the transmission of pain signals from the head or neck, and so reduces the frequency of migraine headaches.Does Botox prevent migraine headaches?There have been numerous anecdotal reports of benefit noted after botulinum toxin administration. These have been noted by physicians who were treating patients for a different problem or for cosmetic effect. When it was noted that these patients reported improved migraine control, further investigations were launched. The academic literature has been mixed on the effect of botulinum toxin A on migraines. Some example studies follow:There was a study performed by Saper et al (Pain Medicine, 2007) during which botulinum toxin A was injected into one of three distributions of the forehead or temple, all three areas (total dose, 25 units) or placebo (no drug) injections. There was no difference noted between placebo and the other types of injections. Another botulinum toxin study (Cephalalgia, 2007) involved Botox again in the prevention of migraine headaches. In this study, which involved multiple treatment doses (as high as 225 units) no significant difference was detected in mean number of headaches compared to placebo. One of the better studies (Silberstein el al, Headache, 2000) included 25 unit and 75 unit doses and, in addition, a placebo group. The study was double-blinded, meaning neither the physicians nor the patients knew who was getting the placebo versus the active drug. The result was that those getting the 25 unit doses had significantly fewer migraines per month, the migraines were less severe, they had less vomiting, and they used less medication to treat acute attacks. Interestingly, only the 25 unit dosing was found to be significantly (statistically) superior to placebo - whereas the 75mg dose did not reach statistical significance and was associated with more adverse effects. There are other studies, but suffice it to say that the data is mixed. Who should try Botox?Many headache centers, such as our own, offer botulinum toxin A to patients who respond poorly or not at all to multiple preventative oral medications. It may also be offered to patients who have frequent migraine headaches and who are suffering from abnormal head, neck, or shoulder posture or who experience excessive muscle spasm.Return from 'Botox for Migraine Headaches' to Migraine Headaches
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