Sometime in the fall of 2010, the FDA is expected to officially approve Botox as a treatment for headaches. This will be the first time many people hear of this treatment option -- which takes an unusual approach to headache pain, to say the least. But the announcement will officially confirm what many headache sufferers have already discovered on their own: Botox injections do, in fact, treat and prevent migraines.
Botox as a treatment for headache was discovered entirely by accident. Migraine sufferers receiving Botox injections to reduce wrinkles noticed that it seemed to ease their headaches -- or even prevent them entirely. Word spread and researchers undertook studies, but headache sufferers didn't wait. They began quietly seeking Botox treatment despite the lack of official approval. (Botox is approved for wrinkles, so extending the treatment to headaches is considered an "off-label" use.) While the first studies focused on migraines, researchers soon began to study the effect of Botox on all types of headaches.
How does it work?
Doctors aren't certain just how it works, which is one of the reasons the treatment has been considered experimental for so long. Botox is a protein that's derived from the bacteria that causes botulism, a severe form of food poisoning. Technically a toxin, it paralyzes muscles when injected into muscle tissue -- hence the legions of celebrities with frozen foreheads.
In the last ten years, Botox has been approved to treat numerous conditions, including:
Vocal cord spasms
Excessive armpit sweating
Botox works for these conditions by paralyzing the muscles or glands causing the problem -- the eyelid muscle or the sweat gland or the facial muscle, for example. When it comes to headaches, the doctor or other practitioner typically injects Botox into the forehead, neck, and shoulders in spots where patients are experiencing pain or tension. The Botox paralyzes the muscles, preventing tension and decreasing strain on the central nervous system.
But many doctors are now convinced that Botox does more than freeze muscles; it also seems to block pain receptors in nerve cells. The theory is that it works by blocking overactive nerve impulses that trigger glandular activity contributing to headaches and by blocking the nerve impulses that transmit pain.
Botox for headaches: Safety and effectiveness
What's the evidence that Botox works?
Over the past five years, researchers have conducted several fairly convincing studies of Botox and headaches. One of the first, conducted five years ago, followed more than 500 people who typically suffered from headaches on 16 out of every 30 days, or about half of all their days. The researchers used a double-blind placebo-controlled study structure, so the patients didn't know if they were being injected with real Botox or a placebo. The conclusion: On average, Botox injections cut participants' headache frequency in half. The same results were found in a larger study conducted as part of the British approval process. In this study, also double-blind and placebo-controlled, more than 1,300 people were followed, and again Botox was found to reduce the number of headaches by almost half.
Is Botox for headaches safe?
That's what the FDA has been looking into, as required for approval. The official answer: We can't yet declare Botox safe for use in treating headaches. But unofficially, the evidence is pretty convincing. In July 2010, the U.K. approved Botox as a treatment for headaches, and it seems likely the U.S. will follow suit.
Although Botox treatment only came into wide use in the 1980s and '90s, the bacterium, officially known as Clostridium botulinum, has been studied for its health properties ever since it was isolated and named back in 1895. Extensive clinical trials were conducted before Botox was proved safe for use on wrinkles, sweating, and eye twitches. In the clinical trials conducted to determine safety, the side effects reported were mainly superficial, such as droopy eyelids or muscle weakness.
Will Botox work on my headaches?
It depends on what type of headaches you have, how often and how badly you get them, and whether you can afford it. Botox was originally researched for migraines, then for tension headaches. It works best on headaches that have some connection to muscle tension or blood flow. And because Botox injections last just four to six months, you'd need to get them repeatedly to give yourself the ongoing benefit. This can get expensive. Currently, Indiana, Kentucky, Ohio, and West Virginia are the only states in which Botox treatments for headaches are covered by insurance.
If you're interested in this use of Botox, start by discussing the injections with your doctor. If you come up blank or encounter resistance, you may need to see another doctor. If possible, get a referral to a specific Botox practitioner with extensive headache experience. However, many doctors will be unfamiliar with this treatment, and you'll have to seek a recommendation through friends, neighbors, and acquaintances.
If you know anyone who has successfully been treated with Botox for headaches, ask for a referral and get details on exactly what type of treatment worked for them. Just as headache sufferers were the ones who discovered that Botox helped prevent their pain, it's fellow patients who are going to be your best resource when it comes to pursuing treatment for yourself.