Healthbeat Report: Poisoning Headaches

April 7, 2011 8:34:24 PM PDT
Botox is known as a wrinkle smoother, but it's also used to treat medical conditions, including chronic migraines.

Like many medical discoveries, the migraine relief was found by accident. For years some patients who got the neurotoxin for wrinkles were reporting fewer, less severe migraines. It's now an approved treatment. While many migraine patients are willing to try just about anything to stop the pain, this alternative approach may involve more than most patients can handle.

Michelle Zimet juggles a lot in her busy life: four children, pets and a full time job. Until recently, her hectic days were also filled with crippling migraines -- sometimes up to five headaches a day. Medications weren't working. Zimet was desperate so when Northwestern neurologist Dr. Katherine Carroll suggested Botox, Zimet was game.

"If you are a migraine sufferer, you will try almost anything," said Zimet.

Last October, the FDA approved Botox for those who experience 15 or more days of migraine headaches per month and are not responding to other therapies.

It may sound easy -- a couple of shots, fewer headaches and the added benefit of fewer wrinkles. That's not always the case. To the surprise of many patients, the FDA recommended treatment is 31 injections in seven areas, including the forehead, the back of the head, the neck and shoulders.

"It did freak me out," said Zimet.

It's not a permanent fix, however. The treatment needs to be repeated about every three months.

Dr. Carroll is following the FDA guidelines of 31 injections for each treatment. She says her patients are seeing a benefit.

"A decrease in the number of days with migraines and also a decrease in the number of hours with migraines," said Dr. Carroll.

Researchers are still trying to understand how this drug may help migraines. It may work by relaxing muscles around nerves or blocking pain signals from reaching nerve endings.

Newer research is showing the type of migraine appears to make a difference in whether Botox can provide relief. It appears to specifically work for something called ocular migraines described as crushing or eye popping.

"What we do know for certain patients it really works," said Dr. David Song, plastic surgeon, University of Chicago Medical Center.

Adriana Rodriguez is a receptionist for Dr. Song and a patient. She's hoping the decrease she noticed in her migraines several months ago after Botox wasn't a fluke.

"I've had Botox before for a little maintenance," said Rodriguez. "This is the first time for the migraines."

Dr. Song has a different approach and only injects the specific area where the headaches are focused.

"So it turns out to be 7-10 injections. Very few get 31 injections and I think that is the upwards limit of what surgeons would do," said Dr. Song.

Zimet had the 31 injections in mid February and says she got past the unease of so many shots and it was worth the brief discomfort. Her migraines are now much less frequent. She's due for another treatment in May.

"Is Botox the cure all? No. Has it been a lifesaver? Initially, absolutely because it made me almost human again," said Zimet.

Possible side effects include neck pain and headaches.

Botox is not considered an effective treatment by everyone in the medical community and it can be cost prohibitive. Some insurance companies cover costs but depending on how many shots are given at each treatment, the price can range from $350 to $1,000 or more. This treatment is is not for the occasional headache or migraine.

Migraine: MedlinePlus

Botox - Allergan