Botox Shots: May treatment migraine headaches

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Sept. 28, 1999 (Cleveland) -- Plastic surgeons have been using injections of the nerve paralyzer botulinum toxin type A, called Botox, to smooth wrinkled brows for several years, but now a study suggests that it may also prevent migraine headaches. Plastic surgeon William J. Binder, MD, presented the study at the 103rd meeting of the American Academy of Otolaryngology, Head and Neck Surgery in New Orleans.

Binder, a clinical professor of head and neck surgery at the University of California, Los Angeles, tells WebMD, "I discovered this back in 1992 when I was first injecting Botox to treat forehead furrows. I kept this to myself for more than two years because I wasn't sure that the effect was real." Now he says it's very real, preventing migraine for three months or more. And he says that a shot of Botox in the forehead of a person in the throes of a "sick headache" can stop not only migraine pain but also the nausea and vomiting that often accompany it. "And it can do that in just a little over an hour," he says.

Although Binder gradually came to believe his patients who said the Botox was ridding them of headaches, he decided the claim needed a study to back it up. In 1994 he and his co-authors Mitchell Brin, MD, of Mount Sinai Medical Center, New York, and Andrew Blitzer, MD, of the College of Physicians and Surgeons at Columbia University, New York, began enrolling people in a study to determine if Botox could be a treatment for migraine.

The researchers found that Botox prevented migraine in about half of the almost 100 patients undergoing prevention treatment and it stopped migraine in its tracks in 8 of 13 patients who were treated for attacks.

Although he was comfortable with his results, Binder says he thought the information should be passed on to the physicians who normally treat migraine: neurologists. So in September 1997 he met with 12 neurologists. "Allergan [the maker of Botox] put the meeting together, and I presented my results," he says. After that, those neurologists began their own studies. Currently there are four on-going trials, he says.

Headache specialists Jack A. Klapper, MD, of Denver, and Ninan T. Mathew, MD, of the Houston Headache Clinic, presented preliminary results from one of those studies -- a trial of Botox vs. placebo in 123 migraine patients -- at both the American Association for the Study of Headache and the American Academy of Neurology meeting earlier this year. They also found that Botox reduced the severity and frequency of migraine for three months.

The FDA has not approved Botox for treatment of migraine so many insurers will not reimburse for the treatments, Binder says. He says that he is currently injecting Botox for migraine, as are Brin and Blitzer. Also he says that several headache centers are offering the treatment. "It costs about $500 to $700 for the initial treatment and $400 to $700 for subsequent treatment," he says. He adds that the cost may be a bargain in some cases because some "migraine patients are paying $1,000 a month for medication."

Binder says that the benefit from injections should last for three to four months and that in his practice he has a patient who has "gone four years without a headache and another who has gone three years. If that is a placebo, that is the greatest placebo ever.

"Even the greatest drug for migraine has a duration of action of three to four hours; this has a duration of action of three to four months. ... If the results of on-going trials continue to pan out like they have in our study, [Botox] is something really major," he says.

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