How to Prevent a
There's a new wrinkle on headache
cures: botox. It often works when nothing else does.
BY SANJAY GUPTA
Half the 28 million Americans who
get migraines never see a doctor about them. That is a shame, because not
only are there plenty of drugs that can alleviate the often debilitating
pain of migraines, but there are also whole
classes of medications that can prevent
them in the first place. These include beta and calcium-channel blockers
that improve the flow of blood to the brain, anti-depressants that regulate
levels of the brain chemical serotonin and various antiinflammatory drugs
and anti-seizure medicines (epilepsy and migraines, for reasons no one yet
understands, seem to have common origins).
Unfortunately, a large group of migraine
sufferers — perhaps as many as 9 million in the U.S. alone — find no protection
or relief in today's drugs. That is why there was so much excitement at
the American Headache Society last week in Seattle about the news that
these so-called refractory migraine patients respond well to treatment
with Hollywood's new favorite drug: botox.
The discovery that botox can prevent
migraines was a lucky accident. Plastic surgeons using diluted botulism
toxin to remove wrinkles started hearing about a secondary effect. "Patients,"
remembers Dr. William Binder, "came back saying, 'Not only have my wrinkles
disappeared, but my headaches are also gone.' "
As word spread in the medical community,
more doctors began offering botox to their migraine patients. Finally,
two years ago, a team of scientists at Wake Forest University decided to
put the treatment to a scientific test. They administered botox shots to
134 patients who had not responded to standard migraine
treatments. Eighty-four percent reported
some improvement; among patients who got the full four-session treatment,
the success rate was 92%.
Dr. Todd Troost, chairman of neurology
at Wake Forest and lead researcher on the botox study, says he is not entirely
sure why botox works. "It appears to relax muscles in the head, neck
and jaw that when inflamed may trigger migraines," he says. But Troost
adds that it also seems to interfere directly with the brain's pain-signaling
The FDA, which in April approved
botox injections for wrinkle removal only, has not yet endorsed botox as
a treatment for migraines — although doctors are able to administer it
to patients "off label." The treatments are neither easy nor cheap. They
involve 30 or 40 injections around the head, temple, jaw, neck and
shoulders, cost $1,000 or more and wear off after three or four months.
Some patients will still prefer less invasive preventive measures, such
as getting plenty of sleep and cutting back on red wine, chocolate and
Yet Shirley Kennedy, 52, speaks for
many patients when she swears by her botox shots. For 30 years, she says,
she suffered from migraines so severe that she felt "as if every hair on
my head was about to blow off." That has all changed. "Botox was a lifesaver,"
she says. "I no longer have migraines." She probably has fewer wrinkles
Dr. Gupta is a neurosurgeon and a
CNN medical correspondent
With reporting by Miriam
From the July
1, 2002 issue of TIME magazine