Jewish World Review June 20, 2002 / 10 Tamuz, 5762

Botox injections knock out migraines

By Bruce Sylvester | (UPI) Quarterly injections of small amounts of botulinum toxin, commonly known as Botox, can prevent debilitating headaches in most patients who do not respond to other medications, researchers reported this week.

"We now have a new treatment for severe headache without the noxious side-effects experienced by patients using many current therapies," Dr. Stephen Silberstein, president of the American Headache Society and professor of neurology at Thomas Jefferson University Medical School in Philadelphia, told United Press International. The announcement was made at a news conference preceding the opening of the annual meeting of the American Headache Society.

Botox is a purified form of botulism, an often-fatal poison found in tainted foods. Though not yet approved for headache treatment, the U.S. Food and Drug Administration has approved Botox for other medical uses. Once a drug is FDA-approved for one use, however, doctors may prescribe it for any use.

Migraine headaches affect about 17 percent of women and 6 percent of men in the United States. About 5 percent of the population has chronic daily headache.

"Migraine is the leading cause of disability in the world, measured by days missed from work and suffering among working age people," lead researcher Dr. Todd Troost, professor of neurology at Wake Forest University Medical School in Winston-Salem, N.C., told UPI.

"Botox therapy is safe, effective and essentially carries no risk for headache sufferers. It will permit many patients to get completely off all other medications and avoid their side effects. And if a patient has to rarely take an acute medication for a severe migraine, we have found that prior Botox therapy will enhance the potency."

Botox partially paralyzes muscles for about three months. For headaches, it is injected into muscles around the eyes, forehead and sometimes the jaw. Patients whose headaches involve the entire head get additional injections in the upper back of the neck and the shoulders.

Troost and his research team evaluated 134 subjects with migraine headaches, tension headaches or headaches occurring at least 15 days a month. A majority of the subjects had been treated unsuccessfully with at least three other headache medications. The subjects received up to four Botox treatments at intervals of three months. Following each treatment, the patients described the results by using a five-point scale -- 1: "no improvement," 2: "mild improvement," 3: "moderate," 4: "good," and 5: "excellent effect."

Of those who had four treatments, 92 percent reported improvements, with a mean score of 4.3 for the group, and 84 percent reported some improvement.

"There are significant improvements that appear to be progressive and may also be cumulative," Troost said. "I tell patients that it is important not give up if it has only a mild effect the first time. The second or third time it really seems to work better."

Troost said patients with debilitating headaches often do not get results from medications designed to treat acute attacks. As a result, they often misuse over-the-counter and prescription pain medications. "Botox now offers an alternative to daily medication for frequent migraine sufferers, and it is a safe way for them to get off dangerous pain pills, prescription and over-the-counter, that these patients use in excessive amounts," he said.

Troost added that FDA-testing of Botox for headaches has begun and, supported by the new findings, should move forward, "so that the FDA will eventually approve Botox as a recognized effective therapy for headache."

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© 2002, United Press International