There's a new wrinkle on headache cures : botox. It often works when nothing else does By Sanjay Cupta,M.D.
Half the 28 Million
Americans who get migraines never see a doctor about them. That is a shame,
because not only are there plenty of drugs that can alleviate the often debilitating
pain of migraines, but there are also whole classes of medication that can
prevent them in the firste place. These include ceta and calcium-channel
blockers that improve the flow of blood to the brain ? Anti-depressants
that regulate levels of the brain chemical serotonin and various anti-inflammatory
drugs and anti-seizure medicines (epilepsy and migraines, for reasons no one
yet understands, seem to have common origins).
Unfortunately, a large group
of migraine suffers-perhaps as migraine sufferers –perhaps as many as 9 million
in the U.S. alone –find no protection or relief in today’s drugs. That is why
there was so much excitement at American Headache Society last month in Seattle
about the news that socalled refractory migraine patients respond well to
treatment with Hollywood’s new favorite drug :botox.
The discovery that botox
can prevent migraine was a lucky accident. Plastic surgeons using diluted
botulism toxin to remove wrinkles started hearing about a secondary effect. « Patients, »
remembers Dr. William Binder? ‘’came back saying, Not only have my wrinkles disappeared,
but my headaches are also gone. ‘’
As word spread in the
medical community, more doctors began offering botox to their migraine
patients. Finally, two years ago, a team of scientists at Wake Forest
University in North Carolina decided to put the treatments to a scientific
test. They administered potox shots to 134 patients who had not responded to
standard treatments. Eighty-four percent reported some improvement; among
patients who got the full four-session treatment, the success rate was 92%.
Dr. Todd Troost,
chairman of neurology at Wake Forest and
lead research on the botox study, says he is not entirely sure why botox works.
‘’It appears to relax muscles in the head, neck and jaw that when inflamed may
trigger migraines, ‘’ he says. But Troost adds that it also seems to
interfere directly with the brain’s pain-signaling mechanism.
The FDA, which in April approved
botox injections for wrinkle removal only, has not yet endorsed botox as a treatment
for migraines-although doctors are able to administer it to patients ‘’of
label.’’ The treatments are neither easy
nor cheap. They involve 30 or 40 injections around the head, temple, jaw, neck
and shoulders, caste $1,000 or more and wear off after three or four months.
Some patients will still prefer less invasive preventive measures, such as
getting plenty of sleep and cutting back on red wine, chocolate and aged
cheese.
Yet
Shirley Kennedy, 52, speaks for many patients when she swears by her botox
shots. For 30 years, she says, she suffered from migarines so severe that she
felt ‘’as if every hair on my head was
about to blow off’’ that has all changed . ‘’Botox was a lifesaver ,’’ she
says. ‘’I no Ionger have migraines.’’ She probably has fewer wrinkles too.
With reporting by Miriam C. Falco/Atlanta (TIME magazine July 2002)
