DEAR DOCTOR K:
I suffer from chronic migraine headaches. My doctor mentioned Botox injections as a possible treatment. Can you tell me more?
I’ll bet you were surprised when you told your doctor you needed treatment for your migraines, and he or she said, “You need Botox!” After all, what does removing wrinkles have to do with headaches?
Botox can do much more than remove wrinkles. Botox — short for botulinum toxin — is a substance made by the bacteria responsible for botulism. This is a foodborne illness that causes paralysis and sometimes death. When purified and diluted to very small concentrations, however, Botox is a safe and useful drug. It’s an example of how a little bit of a bad thing can be good.
Botox is a muscle relaxant. Tense muscles under the skin tug the skin and cause wrinkles, and that’s why the first use of Botox as a treatment was as a wrinkle-buster. Since then, however, many other medical conditions that are caused by tense muscles have been treated successfully with Botox.
Clinical trials have found that Botox injections reduce the frequency of headaches in people with chronic migraine headaches. In 2010, the FDA approved Botox for this purpose. But Botox treatment has been shown to be effective only for chronic migraine headaches — migraines suffered at least 15 days a month. For migraines that are less frequent than that, there is little evidence that Botox helps. Since most people who suffer from migraines do not have chronic migraines, Botox has nothing to offer them.
At the same time, Botox is not the first treatment to try for chronic migraines. It is more risky and expensive than various pills and works no better. In fact, some people with chronic migraines benefit from even simpler treatments. For example, apply a heating pad to your neck and shoulders every day. Consider massage, ultrasound or gentle stretching to relieve muscle tightness.
Something else to consider: More than half of chronic headache sufferers use painkillers frequently. After initially helping the pain, regular use of painkillers can make headaches worse — it’s called “medication overuse headache.” Caffeine-containing painkillers are most often to blame.
If your headaches are complicated by medication overuse, you need to stop the drugs. Doctors say going “cold turkey” works best. But another option is to gradually wean yourself off painkillers. Cut back a little each day. Enlist your doctor’s help with this withdrawal process.
If you decide to try Botox therapy, find a doctor who has experience doing the injections. This treatment requires 31 injections to be given in various locations along the head, neck and shoulders. (I’ve put an illustration showing the Botox injection, below.)
Be aware that Botox therapy requires repeat injections, and the benefits may last only a few months after each treatment. Most of my patients with chronic migraines get relief from other, simpler treatments. But for some, Botox has been a boon.
Botulinum toxin for chronic migraines