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Botox Irons Out Tough Headaches

Injections Prevent Migraines, Even in Hardest-to-Treat Patients


Exactly a week earlier, the Tobaccoville, N.C., secretary received her first Botox injections from neurologist Todd Troost, MD, of Wake Forest University Baptist Medical Center. Troost has treated roughly 350 migraine and headache patients with Botox, and he has seen results similar to Beck's in many of them.

"In my mind this is the best treatment we have right now, especially for patients who do not respond well to drugs," he tells WebMD. "It doesn't work for everybody, but we have found that it works for about 87% of patients who have not done well on other therapies."

Troost presented findings at the Seattle conference on 134 such patients who were given one to four cycles of Botox. Overall, about 84% of all patients reported improvement in their headache pain. Among patients who received four cycles of Botox, 92% improved.

Researchers from Houston's Baylor College of Medicine Headache Clinic reported on 60 patients with chronic daily headaches treated with either Botox injections or placebo injections containing only water. After 12 weeks, more than half of those treated with Botox (53%) reported moderate improvement in headaches, compared to 7% of those given the placebo injections. Patients who received two cycles of Botox had better responses than those who received just one cycle.

Botox won FDA approval as a wrinkle remedy in April, but it has not been approved for migraines. Most health insurance companies do not currently cover the treatments, which cost between $800 and $1,000 a cycle. Beck paid for her treatment out of pocket, but Troost says many of his patients cannot afford to do that.

"I just admitted a patient to the hospital last night," he says. "She did wonderfully on Botox, but her insurance wouldn't pay for it. We gave her one cycle for free, but then she had to go back to her old medications and she ended up in the emergency room."

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