The Early Results on Botox for Headaches

If you have migraines, you've probably noticed news stories about Botox injections. This procedure sounds absolutely insane because it involves injecting the botulinum toxin type A, which is the bacteria that causes botulism (a severe form of food poisoning), into the muscles around the eyes.

Since 1968 scientists have been experimenting with botulinum toxin injections for various other conditions, including lazy eye and blepharospasm (spasm of the eye muscle). Patients noticed that the injections also erased wrinkles in the treated area, so plastic surgeons began to use the injections specifically for that anti-wrinkle effect.

All of this led accidentally to the discovery that patients who had the injections didn't have migraines, or at least had less severe headaches. The drug lasts for three to four months, and that's how long patients reported being free of migraines.

In 1989 a pharmaceutical company, Allergan, Inc., bought the rights to produce the toxin under the brand name Botox, which is approved for use in strabismus and blepharospasm in patients 12 years old and older.

According to Allergan's website, the reason it works is that it affects "the peripheral nerve terminal at the neuromuscular junction by blocking the release of acetylcholine. Affected terminals are inhibited from stimulating muscle contraction, resulting in a reduction in muscle tone." Because of its effect on the nerves, it somehow blocks headache pain.

At this point we're seeing the results of initial studies. One at UCLA was actually a study of wrinkle patients done by a plastic surgeon, Dr. William J. Binder, and another was conducted by the University of Toronto's Faculty of Dentistry. This second one, incidentally, was supported by Allergan.

The Toronto study involved two groups, one of which was given a placebo. All of the patients were suffering headaches along with neck pain, and they received injections in the head and neck. The treatment group not only showed reduction in pain, they had greater range of movement of the neck.

Both of these studies seem to show that Botox does work for migraine and has no side effects except for the possibility of temporary pain and/or a purple hue at the sites of injection. The down side is considerable, though. Each treatment requires several injections, and one estimate of the cost is $700 to $1,000 per treatment. It must be repeated every three to four months when the effect of the drug wears off.

Another caution is that headaches triggered by anything other than muscle contraction probably would not be helped by this treatment. Some patients wouldn't be candidates for Botox because of other medications they take or other medical issues.

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