botox and migraines

Botox® May Offer Relief to Migraine Sufferers

Dermatologists commonly employ a treatment for facial wrinkles that may also offer relief to individuals plagued by migraines, according to findings presented by a UCSF researcher.

Dr. Richard Glogau, a professor of dermatology at UCSF, shared his observations at the American Society of Dermatologic Surgery meeting, held from November 2 to 5. In his case study, he reported that 75 percent of the 24 patients experienced relief from migraines lasting four to six months after receiving Botox® injections, a substance derived from botulinum toxin A, a bacterial source. Glogau’s research contributes to the growing body of evidence suggesting that botulinum toxin A could be an effective solution for headaches.

Since 1992, Botox®—originally notorious for causing fatal food poisoning—has been purified and diluted for medical use. It is now used to temporarily paralyze specific facial muscles, reducing wrinkles in areas such as the forehead and around the eyes and mouth. Intriguingly, patients in Glogau’s dermatology practice who received botulinum toxin A injections for cosmetic frown lines in the upper third of their face reported an unexpected benefit: relief from migraine headaches.

This serendipitous discovery prompted Glogau and other researchers to explore the injection points and dosages that could alleviate headaches. Glogau’s findings reveal that injecting botulinum toxin A into the muscles of the brow, eyes, forehead, the side of the head, and the back of the head near the neck (an area previously overlooked by researchers) can lead to immediate headache relief and provide benefits lasting up to six months. The average dosage administered in his case studies was 80 units per patient.

The exact mechanism behind migraine relief is not fully understood, but Botox® injections effectively paralyze facial and head muscles. Glogau theorizes that botulinum toxin A may prevent pain expression by halting muscle contractions that trigger spasms or inhibit nerves responsible for transmitting pain signals to the brain and spinal cord. Most likely, it achieves both of these effects.

It’s important to note that there are no published, randomized, double-blind trials that definitively establish the safety and efficacy of Botox® for migraine treatment. Existing data primarily consists of case reports and meeting abstracts. Two earlier studies, presented at the 1999 American Association for the Study of Headache meeting, offered some promising results. One study reported that a one-time injection of 25 units of botulinum toxin A into the brow, forehead, and side of the head reduced migraine frequency, pain severity, vomiting, and pain medication use for up to three months. A 75-unit treatment provided relief but also led to side effects like eyelid drooping. Another study from the University of California, Los Angeles, indicated that 51 percent of 96 patients experienced complete migraine pain relief.

Glogau emphasizes that Botox® doesn’t work for everyone or all types of headaches. However, when physicians begin with injections in the eyebrow area, similar to the approach used by dermatologists for wrinkle treatment, and gradually work toward the back of the head, the response rate seems to improve.

Moreover, Glogau underscores the importance of precise dosages and injection techniques for achieving migraine relief. Too much of the drug in one area, especially close to the eye, can affect eye muscles and result in drooping.

Patients who experienced successful treatment in Glogau’s case studies had long-standing migraine diagnoses, had consulted with neurologists, and were taking standard migraine medications, including sumatriptan (Imitrex). Some even required narcotic medication to alleviate the pain of their frequent headaches, with many experiencing migraines at least once a week, and some suffering daily.