PHILADELPHIA – Good news for older migraine sufferers: A new study finds that Botox can help headaches and smooth out wrinkles at the same time.
The versatile botulinum toxin reduced the number of headaches in people with the worst kind of headache pain – Chronic Daily Headache (CDH) with migraine.
“Those are the most intractable, most difficult patients to treat,” said Stephen Silberstein, a neurologist who directs the Jefferson Headache Center at Philadelphia’s Thomas Jefferson University Hospital and took part in the study. It was presented Thursday at an American Academy of Neurology’s meeting.
People with CDH have headaches on more than 15 days out of 30, Silberstein said. Most have migraines – headaches marked by sharp pain, nausea, vomiting and vision problems. About 2 percent of the population falls into that category – 80 percent are women.
Currently, there’s no effective treatment for many of these patients. “A lot of people take narcotics every day and all kinds of stuff,” Silberstein said.
The study was funded by Botox-maker Allergan Inc. Allergan now plans to begin a Phase III clinical trial aimed at FDA approval for this type of headache, it said in a news release.
Some headache experts have long suspected that Botox helps headaches, said Christine Lay, a neurologist at the Headache Institute at Roosevelt Hospital in New York. Patients who used it to get rid of wrinkles said their headaches went away, too.
Previous studies have supported the idea, but not all were as well designed, said Lay, who was not involved in the CDH study but has been a consultant to Allergan.
Ausim Azizi, a neurology professor at Temple University, said he believes Botox is most useful for people whose migraines are triggered by tension headaches.
The most recent research, conducted at more than 20 sites around the country, examined 228 patients from a larger trial who were not taking any medicines to ward off headaches, Silberstein said. Botox was more effective for them than for people who were taking preventative drugs.
During the nine-month study, patients received either Botox or placebo shots every 90 days. The number of headaches per month fell from 14 to 4.2 in the Botox group and from 13 to about 8 in the placebo group.
Botox prevents the brain from becoming “hyperexcitable,” Silberstein said. “The basic problem with migraine is irritation of nerve endings in the tissue surrounding the brain.” Botox quiets those nerve endings.
The treatment has the bonus of relaxing wrinkles – if headache pain coincides with wrinkled areas. Headache sufferers with laugh lines – or more likely frown lines – around the mouth are out of luck.
Lay said she’s been treating headaches with Botox for five years. “Every Thursday, I do Botox patients all day long.”
Insurance rarely covers the injections, which cost as much as $1,000, she said.
Lay injects it in the muscles in the forehead, lines between the eyes, the temple, the back of the neck or shoulders. Patients tend to be headache-free for six to seven weeks.
One man who’d gotten injections in his forehead joked with her when he returned for more shots. “It didn’t really help my headaches, but I look so … good I want to try this again,” he said. The second time, Lay said, it worked.
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