TUESDAY, April 24 (HealthDay News) -- Botox is considered a
preventive medication for debilitating migraine headaches, but a
new review finds that it may only help people with chronic
migraines or chronic daily headaches. And, even then, the effect
appears to only be "small to modest."
The review found that Botox (botulinum toxin A) was no help for
people with episodic migraines (fewer than 15 a month) or chronic
"Our analyses suggest that botulinum toxin A may be associated with improvement in the frequency of chronic migraine and chronic daily headaches, but not with improvement in the frequency of episodic migraine, chronic tension-type headaches or episodic tension-type headaches. However, the association of botulinum toxin A with clinical benefit was small," wrote the authors of the review.
Still, the review's lead author, Dr. Jeffrey Jackson, said, "If
I was having more than 15 migraines a month, I'd give Botox a try.
It has few side effects. And, if it helps, you can go 90 days
without as many headaches and without daily side effects." Jackson
is a professor of medicine at the Medical College of Wisconsin in
Results of the review are published in the April 25 issue of the
Journal of the American Medical Association.
More than 40 percent of adults experience tension-type headaches
at some point in their lives, according to background information
in the article. Between 8 and 18 percent of adults have had
Treatment for these serious headaches fall into two general
classes: abortive or preventive. The abortive medications are
faster-acting, and can help stop a migraine or its symptoms while
it's occurring. Preventive medications are taken to stop the
headaches from occurring in the first place.
Botox's effect on migraines was discovered coincidentally when
people who were having Botox injections to lessen lines and
wrinkles in their foreheads noticed that their headaches were
The current review examined 31 clinical trials. Twenty-seven
were comparisons of Botox to placebo, including 5,313 patients. The
remaining four studies were randomized clinical trials comparing
Botox to medications commonly used to treat serious headaches. The
drugs included amitriptyline (Elavil), prednisone, topiramate
(Topamax) and valproate (Depakote).
When the researchers looked at the placebo-controlled trials,
they found that Botox was associated with about two fewer headaches
a month for people with chronic migraines and those with chronic
daily headache. There was no statistically significant difference
in people with episodic migraines or chronic tension-type headaches
who were treated with Botox vs. placebo.
Botox wasn't associated with a reduction in the frequency of
chronic migraines compared to topiramate or amitriptyline, or in
the reduction of frequency of chronic or episodic migraines
compared to valproate, according to the review. Botox did reduce
headache severity more than methylprednisone, according to one
study included in the review.
Side effects from Botox included a drooping eyelid, muscle
weakness, neck pain, neck stiffness, skin tightness and a tingling,
burning or numb sensation on the skin.
"If done properly, there really aren't substantial (side) effects from the use of Botox," explained Dr. Ezriel Kornel, a neurosurgeon at Northern Westchester Hospital in Mt. Kisco, N.Y. "But, over time the effect may wear off. Some people can develop an immunity to Botox."
Both Jackson and Kornel noted that there was a large placebo
effect seen in many of the studies. "It's hard to know if most of
the benefit was from the drug or from the placebo effect," said
Jackson, who added, "but, patients don't care if it's a placebo
Kornel said that the review showed that there is definitely some
benefit from Botox for those with chronic migraine and chronic
daily headache. "Chronic migraines are the hardest headaches to
treat, and this gives us one more treatment in our armamentarium.
It's a reasonable alternative to the use of long-term daily
medications that can have side effects," Kornel said.
He said there are also other treatments that can help these
types of headaches, and what's most important for someone who has
debilitating headaches is to see a doctor who specializes in
treating headaches. "A headache specialist has the whole array of
treatments at their disposal," he said.
Learn more about migraine headaches and their treatment from the
National Headache Foundation.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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