Botulinum toxin A (Botox) injections can prevent migraines in patients who have headaches everyday. Researchers from the Mayo Clinic in Scottsdale, Arizona conducted a study, which focused on migraine patients with chronic daily headache i.e. those having a headache at least 15 days per month. These patients represented a minority of migraine sufferers, but they account for at least 50 percent of the patients seen in specialty headache clinics. The idea of using Botox as a preventative agent for migraines came in 1992 when a Los Angeles plastic surgeon noticed fewer headaches in a patient who was being treated with the agent for its skin-smoothing effects. Since then, several studies have evaluated botulinum toxin as a migraine preventative. In the current study, 228 patients with chronic daily headache were randomly allocated to botulinum toxin injections or inactive placebo injections of saline every 3 months for 11 months. Injections were placed primarily in the area of the trigeminal nerve, but might continue into other areas as needed to follow the pain. In the current study group, the number of injections during each treatment session ranged from 10 to 25 per patient. Treatment with botulinum toxin reduced the frequency of migraine attacks per month from 14 to 6 a reduction of 55 percent. By contrast, with placebo, attacks dropped from 12.9 to 8.4 per month, for a significantly lower reduction of 35 percent. Treatment with Botox was also linked to a significant reduction in headache severity and with a drop in the use of acute headache medications. Botulinum toxin is currently not approved by the US Food and Drug Administration for use against migraines. New trials will determine whether the FDA approves this drug for migraines.
American Headache Society,
June 2005