New use for Botox: chronic migraines
Dec. 13, 2010
LOUISVILLE, Ky. − A well-known treatment used in cosmetic facial procedures will soon be available for treatment of migraines.
Beginning Monday, Jan. 3, the Comprehensive Headache Program at the University of Louisville Health Sciences Center will add Botox as a treatment for chronic migraine headaches in adults. The move follows the October 2010 approval of the drug for this purpose by the FDA.
Neurologist Dr. Michael K. Sowell, director of the program, has been leading the training of staff in the new treatment protocol. “Chronic migraine patients are defined as those who experience migraine headache more than 14 days per month, and the Botox approval was designed for these patients,” he said.
The protocol calls for Botox to be administered approximately every 12 weeks through multiple injections in the neck and head. In the clinical trials leading to approval, this protocol was shown to decrease the days in which adult chronic migraine patients had pain.
There are differing opinions to explain how it works, said Sowell, who is the only physician in Louisville board certified in both neurology and headache medicine by the American Board of Psychiatry and Neurology. “One theory proposes that tension and spasms are the main causes of migraines, and Botox eliminates the headaches by eliminating the muscle tension. Another theory is that Botox reduces the incidence of headaches by inhibiting the transmission of nerve cell signals."
“What we do know is that it has been approved to be another potentially effective treatment we can offer our patients.”
Migraines differ from other types of headaches in that they are usually accompanied by one or more of the following: nausea, dizziness, vomiting and sensitivity to light or loud noise. Some chronic migraine sufferers do not improve with current therapies, and Botox could be helpful to them, Sowell said. Current treatments include Topamax, an oral medication taken daily to help prevent migraines, and triptans, a family of tryptamine-based drugs, used when migraine strikes.
Botox is best known as a cosmetic treatment to smooth lines between the eyebrows, but it also is FDA-approved to treat uncontrolled blinking, crossed eyes, certain neck muscle spasms, excessive underarm sweating and effects of muscle spasms in the elbows and hands.
Sowell said he is aware that Botox has been used elsewhere for migraine “off-label” − prior to its approval − but he cautions that it should only be administered for migraine treatment by a clinician trained in its use. “Botox is the newest, but certainly not the only treatment option we can provide to migraine sufferers,” he said. “As with any medication, it should be administered only by a trained, licensed professional when warranted as part of the patient’s overall treatment plan.”
The Comprehensive Headache Program at UofL treats patients with headache, facial and neck pain through a wide-ranging array of treatments. The adult program is housed in the Health Care Outpatient Center, 401 E. Chestnut, in Louisville. Appointments can be made by calling (502) 589-0802.