Headache sufferers are finding relief from migraines from an unexpected source: Botox, the drug best known for reducing wrinkles.
Wayne T. Cornblath, M.D., neuro-ophthalmologist at the University of Michigan Kellogg Eye Center, says that many of his patients are relieved to find that Botox makes their once debilitating headaches manageable.
Mary Anne Brancheau is one such patient who characterizes the treatment as "life altering." Now that the injections are working, she realizes the magnitude of the pain, frustration and fatigue that accompanied her daily headaches. "I tried other medications for years, but nothing really worked. Before, I'd describe my quality of life as mediocre; now I'm productive again, and I'd classify the quality of life as a ten," she says.
Doctors discovered this new use for Botox just a few years ago, when patients reported fewer headaches after receiving injections to reduce wrinkles. Several clinical trials followed, and in June 2002 researchers at the annual meeting of the American Headache Society reported on a study of 134 individuals, most of whom, like Ms. Brancheau, had little success with conventional medications.
Some 84 percent said that Botox had lessened the pain from their migraine, tension, or chronic daily headaches. Cornblath says that he sees a similar success rate in his own practice. "In my experience, about one-third of my patients have had complete relief from headaches, and another one-third have found partial relief," he observes.
To treat headaches Cornblath administers approximately ten injections, five in the forehead and five in the back of the neck. The small dose and location of the injections help to minimize side effects, which are generally limited to a slight decrease in ability to move forehead muscles or elevate the eyebrows.
According to Cornblath, "The side effects are negligible, especially when compared to those associated with some of the stronger migraine medications."
The injections take from 1 to 14 days to have an effect, and the benefits last from 2 to 5 months. Ms. Brancheau says that her first treatment took the full 14 days to reduce her headache pain, but each successive treatment worked faster. By the third treatment, she felt immediate relief. Similarly, the effects of each treatment lasted a little longer so that now, Ms. Brancheau has the injections every 5 months. She credits her insurance company for recognizing that it is cost-effective to cover the treatments, given the expense of migraine medication.
Physicians believe that the drug reduces headache pain because it reduces muscle contractions or blocks a pain-transmitting chemical, or through a combination of both actions.
Botox(r) from the beginning
Kellogg eye plastic surgeon Christine C. Nelson, M.D., had an early look at Botox when she completed a fellowship at the University of California, San Francisco in 1984--85), just as Alan Scott, M.D., was investigating the drug's very first clinical use in a nearby lab.
Scott realized in the early 1970s that botulinum toxin could be used to correct strabismus, a disorder of the eye muscles, in which the eyes are misaligned, sometimes crossing. By the time Nelson joined the Kellogg Eye Center in 1985, clinical trials were underway to test Botox as a treatment for facial spasms. Kellogg was one of the ten or so medical centers in the country involved in the trials.
Nelson has been using Botox to treat patients with facial spasms for nearly 20 years. Many of her patients suffer from blepharospasm, a disorder that results in constant and uncontrollable blinking. In its extreme, the condition may render a patient functionally blind. According to Nelson, Botox treatments provide significant relief to more than 90% of individuals who suffer from this frustrating and disabling condition.
She also sees patients affected by hemifacial spasm, a related disorder that affects only one side of the face. Surgery to decompress the facial nerve is often the initial treatment for this disorder, but Botox can be used for those who decide against the surgical procedure.
Botox has been around longer than most people know, observes Nelson. The FDA approved Botox for eye muscle disorders in 1989, but it was not until April 2002 that the drug was approved to reduce the severity of glabeller lines, or frown lines. "In a way, it's curious to see all the recent publicity centered on cosmetics," she observes. "Ophthalmologists were involved in the original clinical work, they did the research, and, as a result, they have the most experience."
For more information, contact the Eye Plastic and Neuro-Ophthalmology Clinic at the U-M Kellogg Eye Center, 734- 763-9142.
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