Botox Irons Out Tough Headaches

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

From the WebMD Archives

June 18, 2002 -- Forty-nine-year-old Robin Beck had her first Botox injections earlier this month, and she has been on top of the world ever since. But unlike the thousands of baby boomers attempting to turn back the clock with Botox, Beck says she couldn't care less about wrinkles.

What she wanted -- and got -- was relief from the agonizing migraines and tension headaches that have tormented her since she was 18. And she is not alone. New research presented this week at the annual meeting of the American Headache Society offers powerful evidence that the hottest thing in cosmetic medicine is also a powerful new tool for preventing hard-to-treat chronic headaches.

Some 13 studies involving more than 650 patients with migraines and frequent tension headaches were presented at the Seattle meeting. Among the major findings:

  • Roughly 90% of patients in one study did well on Botox, even though they had responded poorly to an average of three other medications in the past.
  • The injections seem to be especially useful for patients who experience more than 15 headaches a month and who get little relief from standard treatments.
  • In one study, 68% of those who responded had reductions in migraine-related disability of 75% or more. Responders had an average decrease of 61% in headache frequency and 27% in headache severity.

A purified form of the toxin that causes the deadly food poisoning botulism, Botox is believed to work in migraine patients by deadening the neurotransmitters that cause headache pain in much the same way that it paralyzes facial muscles to reduce wrinkles. Patients typically receive 10 to 25 injections in the head, neck, and shoulders during a treatment cycle, and the effect tends to last for three or four months.

"As far as I was concerned, Botox could give me wrinkles if it just helped my headaches," Beck tells WebMD. "Over the years I have been treated with so many things that I have lost count. But Thursday, June 13 was the first day in 30 years that I have not had a headache."

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."