Botox Treatments Not So Effective for Migraine Headache Relief

Botox is a good way to smooth nasty wrinkles, but the latest studies show it may not do much to ease the throbbing pain of a headache.

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In 2010, the government approved Botox to treat chronic migraines, after some doctors noted that their patients reported having fewer headaches after receiving Botox injections to smooth out their wrinkles. But now a new review of the research suggests that Botox (onabotulinumtoxin A) actually has minimal headache benefit.

Dr. Jeffrey Jackson, professor of medicine at the Medical College of Wisconsin, reported on Tuesday in the Journal of the American Medical Association on a review of 31 trials investigating Botox’s effectiveness in reducing migraine and chronic tension headache symptoms. Studies comparing Botox to placebo showed a slight decrease in the number of migraine headaches per month among Botox users, but no difference between patients when it came to chronic tension headaches. In trials that compared Botox to other headache treatments, there was no statistically significant difference in the number of headaches patients reported each month.

“I was surprised that the [migraine] benefit was so minimal,” says Jackson. “I was also surprised that Botox doesn’t work to relieve tension headaches.”

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Most chronic migraine sufferers who used Botox in the studies experienced just two to three fewer headaches each month on average, compared with those getting placebo injections.

For tension headaches, however, which the American Headache Society says is the most common type of headache, Botox doesn’t seem to be of much help at all. Botox is usually only prescribed for the 3% of adults whose tension headaches occur on 15 or more days a month, at which point they are considered to be chronic tension headaches. In most cases, stress, fatigue, hunger, overexertion or even poor posture can trigger headache onset. That’s why experts believed tension headaches could be particularly amenable to treatment with Botox, Jackson says: the theory was that the muscle-paralyzing drug would relax the contracting muscles that led to shear forces and strain in the skull, which could cause tension headache pain.

But according to his latest results, Jackson says the theory behind what causes tension headaches may need revising. “Botox’s lack of effect on tension headaches suggests that the old theory of muscles contracting is probably not true,” he says.

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In fact, doctors don’t really know what processes in the brain are responsible for triggering either migraine or tension headaches; other theories suggest that the pain is caused by events within the brain. “Why in the world getting injections at different sites on the outside of the head should affect headaches that are supposedly driven by vascular phenomena and weird blood flow inside the brain itself — I don’t know,” he says. “We don’t understand [what is causing] either type of headache.”

So why is Botox approved to treat chronic migraines when it doesn’t seem to reduce episodes dramatically? In the studies that the Food and Drug Administration reviewed before approving the treatment — which were sponsored by Botox’s manufacturer, Allergan — the benefit was most pronounced, says Jackson. When he and his colleagues added in other studies that have been conducted since then, the effect waned. “I suspect that if the FDA knew the benefit was that small, they probably wouldn’t have approved the treatment for migraines,” he says.

Even so, he acknowledges that for migraine sufferers, having two to three fewer episodes a month is a welcome relief, so he recommends that anyone with frequent migraines try Botox injections; the shots are relatively safe, and if they can reduce any headache pain, then they might be worth a try. But people with chronic tension headaches or those who aren’t sacked by 15 or more episodes a month, probably aren’t going to benefit, he says.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

9 comments
Pringy
Pringy

BOTOX for migraine?!!! Yes, believe me , this is working perfectly well!

I'm leaving around a 100 m from Allergan plant at Pringy (France). The new extension of the plant with five huge cooling engine are causing a significant headache to the whole neighborhood, 24 hours a day, 7 days a week. Allergan first did not reacted to the neighbor’s complains. Later, they sad that they were equally surprised by the noise and they are looking for a solution (4 months already and nothing changed). The whole extension suffers from serious deviations that will need to be presented to the court. Hope that for their products they are able to analyze the side effect early in the process :-)

Anyway, I can certify that Allergan Botox can give a strong migraine for long, long time :-(

cynny27
cynny27

Not sure where they got these statistics - but BOTOX for migraines has given me my life back. I have been treated at the Cleveland Clinic now for three years and I now actually have a life. In a 90 day time frame (they don't count the last 10 days - they know botox wears off) I typically have only 1 or 2 migraines ! I was having more than 15 a month. What a dramatic reduction. I am a better mom! A better wife - most importantly I am a better person - I am happier and productive again. Without it - I don't know if I would have been able to go on. It looks like there are a few of us here who believe it it. Plus you know what - it softens the wrinkles too - no complaining about that benefit!

LeonOrleans
LeonOrleans

Pretty much saved my life and is relatively effective. 

AlexanderMauskop
AlexanderMauskop

I've been injecting Botox for chronic migraines and other types of headaches at the New York Headache Center for 20 years and over the years a consistent 70% of my patients responded to this treatment. Many of them had experience similar to KarenV's and RIleyQ's. Here is a short video of me injecting Botox for chronic migraines - http://youtu.be/kwuEcgkBikk#sthash.NhmTSTGX.dpuf

ccmccabe
ccmccabe

I LOVE this!!  I participated in one of the studies for Botox for migraine about 15 years ago.  It makes me really happy to know that in some small way I helped.

KarenV
KarenV

BOTOX has been a life saver for me.  It completely eliminates the photophobia (light sensitivity) that is my main trigger.  Before Botox I had continuous chronic migraines and lost 25 - 50% of my waking hours to migraine.  I took tons of medication.   During a migraine I couldn't exercise, attend concerts, watch movies or walk in the sun and driving was a problem.  Trying to work on a computer was a nightmare.  With BOTOX I can do all those things and take 50% less medication.  I'm healthier and more productive.  

Peter.S
Peter.S

As someone with chronic migraine since childhood and being treated with every ineffectual drug on the market (cafergot and butalbital allowed me to sleep and offered some pain relief as does packing my head in ice) I would love to have two or more fewer per week or month, where do I sign up?

RileyQ
RileyQ

Getting Botox treatments for my migraines has dramatically increased my quality of life. From what my neurologist explains, the mechanism that causes the Botox to help has nothing to do with paralyzing particular muscles, it's about Botox reducing pain messages sent to the brain from both muscles and peripheral sensory nerves. This explains why migraine, which is a brain disorder, can be helped by a procedure directed only at the peripheral nerves. I have literally had a migraine for the past 3 years, since undergoing brain surgery to remove a benign tumor. Even prior to that I had migraines almost daily for many years. I hope that this drug continues to be approved for chronic migraines, because there are plenty of us out there who have found this treatment to be life-altering in a huge way. I am able to pay for it since my health insurance covers the majority of the cost. Thanks for reading, and good luck to my fellow migraine sufferers who are still searching for the treatment that works best for them.