New wrinkle for Botox: Headache relief

Updated 2:00 PM June 16, 2003

New wrinkle for Botox: Headache relief

By Betsy Nisbet
Kellogg Eye Center

Headache sufferers are finding relief from migraines from an unexpected source: Botox®, the drug best known for reducing wrinkles. Dr. Wayne Cornblath, neuro-ophthalmologist at the Kellogg Eye Center, says many of his patients are relieved to find that Botox makes their once-debilitating headaches manageable.

(Photo by Lin Goings, Kellogg Eye Center)

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 10," 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 had little success with conventional medications. Some 84 percent said Botox had lessened the pain from their migraines, tension or chronic daily headaches. Cornblath says 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.

Doctors discovered this new use for Botox just a few years ago, when patients reported fewer headaches after receiving injections to reduce wrinkles.

To treat headaches Cornblath administers approximately 10 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 generally are 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 one to 14 days to have an effect, and the benefits last two to five months. 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.

Kellogg eye plastic surgeon Dr. Christine Nelson had an early look at Botox when she completed a fellowship at the University of California, San Francisco, in 1984-85, just as Dr. Alan Scott 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 10 or so medical centers in the country involved in the trials.

Nelson has used Botox to treat patients with facial spasms for nearly 20 years. Botox has been around longer than most people know, Nelson says. 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 says. "Ophthalmologists were involved in the original clinical work, they did the research and, as a result, they have the most experience."

New wrinkle for Botox: Headache relief

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