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(Botulinum Toxin) Treatment For Wrinkles May Also Relieve Migraines
In a presentation at the American Society of Dermatologic Surgery meeting
(held November 2-5), Richard Glogau, MD, UCSF professor of dermatology, reported
that 75 percent of patients in his case study experienced four to six months of
migraine relief following injections of Botox® (botulinum toxin A derived from
bacteria) to muscles of the face and head. Dr. Glogau's small study of 24
patients adds weight to previous reports that botulinum toxin A can relieve
Since 1992, Botox, the same bacteria that causes deadly food poisoning, has
been used in purified and diluted form to temporarily paralyze the muscles that
bring the eye brows together, thereby eliminating wrinkles in this region. Since
then, it has also been used to mitigate wrinkles in the forehead and near the
eyes and mouth. Patients in Dr. Glogau's dermatology practice injected with
botulinum toxin A in the upper third of the face for treatment of cosmetic frown
lines (who coincidentally suffered from migraine headaches) have reported the
added benefit of headache relief, he said.
Following this serendipitous discovery, Dr. Glogau and other researchers
began to evaluate injection points and dosages that could alleviate headaches.
Dr. Glogau's results indicate that botulinum toxin A injected into the muscles
of the brow, eyes, forehead, side of the head and back of the head near the neck
(a point that earlier investigators have neglected) induce sometimes immediate
headache relief and provide benefit for up to six months, he said. Botox dosage
in his case studies averaged 80 units per patient.
Though the mechanism for migraine relief is not known, Botox injections
paralyze the muscles in the face and head. Botulinum toxin A may stop the
expression of pain by stopping muscle contractions that lead to spasm, he
explained, or it may inhibit nerves that transfer pain responses to the brain
and spinal chord. In all likelihood, it does both, he said.
There are no published, randomized, double-blind trials that show the safety
and efficacy of Botox for treatment of migraines, Dr. Glogau said. In fact, most
of the data consists of case reports and meeting abstracts. Two previous studies
were presented at the 1999 meeting of the American Association for the Study of
Headache. In the first study, reported by researchers at the Michigan Head Pain
and Neurological Institute in Ann Arbor and Michigan State University, a
one-time dose of 25 units of botulinum toxin A injected into the muscles of the
brow, forehead and side of the head, reduced the frequency of migraines, the
severity of pain, vomiting, and the use of pain medications for up to three
months. A 75-unit treatment yielded headache relief, but also side effects like
eyelid drooping. In another study, reported by researchers at the University of
California, Los Angeles, 51 percent of 96 patients reported complete improvement
of their migraine pain.
"It doesn't work on everyone and it doesn't work on all headaches,"
said Dr. Glogau. However, when physicians start with injections into the eye
brow area (the same method used by dermatologists to treat wrinkles) and work
toward the back of the head, the response rate appears to be higher, he
Dr. Glogau also noted that higher dosages of botulinum toxin A administered
with increasingly improved technique may be critical to migraine relief.
"Too much drug in one spot and too close to the eye rim affects muscles of
the eye, causing drooping," he explained.
Patients successfully treated in Dr. Glogau's case studies had long-standing
diagnoses of migraines, had all seen neurologists, and were taking standard
migraine medications, including sumatriptan (Imitrex). Some required narcotic
medication to relieve the pain of their frequent headaches. Most suffered
migraines on a minimum of once a week and several suffered on a daily basis.
In addition to use in prevention of wrinkles, Botox has been used to treat
uncontrolled eye twitching, crossed eyes, muscle spasms and, most recently,
excessive underarm sweating (reported by Dr. Glogau in the September, 1998 issue
of Dermatologic Surgery).
One limitation for botulinum toxin's use in treating migraines is cost. Unlike other treatments for migraines, such as the prescription drug Imitrex and nasal sprays, Botox injections are not covered by insurance and cost about US$350 for each targeted area.A
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