| Ask the Expert
Using Botox® to Treat Headaches |
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Botulinum toxin, commonly referred to as Botox®, has received considerable press coverage since the FDA approved it for cosmetic use to eliminate glabellar lines, the frown wrinkles between the eyes. Yet Botox® has long served other medical purposes, and physicians at the Kellogg Eye Center have used it for nearly 20 years.
For example, Botox® has been effective in helping patients with disabling focal dystonias (movement disorders) that affect the eyes and face. Two such disorders are blepharospasm and hemifacial spasm. The conditions cause repeated involuntary closure of the eyelids—uncontrollable blinking that essentially blinds the patient. Not surprisingly, these chronic conditions take a significant emotional and physical toll on those affected. We are pleased to advise our patients that intermittent injections of botulinum toxin can, in most cases, provide welcome relief.
In the last few years we have found yet another use for Botox®—as an effective treatment for headaches. Some 30% of the population suffers from headaches, a condition that occurs more frequently in women. For some patients headaches are both severe and occur frequently, even daily. While a number of medications can be used to treat headaches, some have side effects or are ineffective.
Several years ago both physicians and patients noticed that patients reported fewer headaches after they had received Botox® injections for forehead and glabellar wrinkles. This led to a number of clinical trials using Botox® for treatment of headache. Roughly two-thirds of the subsequent studies published in medical journals reported that botulinum toxin can relieve migraine-type headache, muscle tension headache, or chronic daily headache. Results can be dramatic. Patients who have suffered from daily headaches for years report being free of headaches for two to five months. In my experience, approximately one-third of patients will have complete relief of headaches, an additional one-third will have partial relief, and the final third will experience no change.
The treatment for headaches consists of approximately ten injections, five in the forehead and five in the back of the neck. Given the small dose and location of the injections, the only potential side effect is a slight decrease in forehead movement or ability to elevate the eyebrows. The injections take from 1 to 14 days to have an effect, and last from 2 to 5 months. Botulinum toxin is thought to work by either reducing muscle contraction, blocking a pain-transmitting chemical, or through a combination of these actions. As this treatment becomes more widely used over the next few years, we will learn more about how the drug works and, thus, will be able to make it even more effective. Perhaps before long, Botox® will be recognized as a standard, useful treatment for debilitating headaches.
