Migraine Sufferers Find Botox Good Not Just for Wrinkles
By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent
Christine Profita Orok has suffered from debilitating migraine headaches since she was a child. She tried everything from acupuncture to narcotic pain pills but nothing worked - until she started getting Botox and nerve block injections.
"I was having attacks quite frequently, to the point where I was having five or six severe ones a month," said the 46-year-old Framingham resident who works in marketing.
"The severe ones could last for days," she said. "There was nausea and vomiting. I couldn't go to work. I would have to stay in bed in the dark and take serious pain medications."
Dr. Zahid H. Bajwa, Director of Clinical Pain Research at Beth Israel Deaconess Medical Center, said Profita Orok was among a sizeable percentage of migraine sufferers for whom typical treatments did not work.
An estimated 1.2 million to 3.6 million people suffer from chronic migraine headaches. About half of them can be helped by over-the-counter pain relievers such as aspirin or non-steroidal anti-inflammatories such as naprosyn, said Dr. Bajwa, also Assistant Professor of Anesthesia and Neurology at Harvard Medical School.
Others benefit from a class of prescription drugs called triptans, which constrict blood vessels in the brain, while about 85 percent of patients benefit from taking both triptans and NSAIDS, he said.
According to Dr. Bajwa, these are sometimes taken to prevent attacks, while at other times they are taken to treat an acute attack. If these don't work, some patients try anti-seizure medications, antidepressants, blood pressure medications or alternative treatments such as acupuncture or chiropractic.
Profita Orok said she tried them all, with no luck.
Then, Dr. Bajwa tried her on a therapy of alternating injections of Botox - Botulinum Toxin Type A - and injections of a local anesthetic combined with a steroid, known as a nerve block. The injections are given every six weeks. They are given to prevent occurrences.
"I would say I've had a 75 percent reduction in pain," she said. "It has dramatically improved my life."
Bajwa said nerve block injections have been used for years to prevent migraines. They help certain patients by quieting muscle spasm activity and blocking peripheral nerves. The injections are given at "trigger points" in the muscles in the back of the head, neck and shoulders, usually as a preventative, and are often combined with a steroid such as cortisone. These are given every six weeks to every six months.
There are also nerve block injections used to treat acute migraine pain - these are given above the eyes or around the temples. These are given when needed, and without steroids.
All of these treatments are covered by insurance.
Using Botox for migraines is a more recent phenomenon, Dr. Bajwa said.
In one study, 80 percent of patients said that after treatment with Botox their head pain was less frequent, less intense, or both. The study focused on 271 patients who suffer from migraines and other head pain, three-quarters of whom had tried many other therapies, without success. Half had been over-using medications in an effort to relieve pain.
Doctors aren't sure why it works. It may be that the toxin may affect the neurotransmitters in the brain. Or it might affect the nerve pathways in some way.
Still, Botox is not approved by the FDA for migraines. As a result, insurers generally don't cover it for migraines, even though doctors utilize it for that purpose in what is known as an "off label" use.
Dr. Bajwa said he is hopeful that the FDA will soon approve Botox for migraines. He said that would be a huge help to patients, since the treatment costs $600 and must be given three to four times per year.
Profita Orok battled her insurance company for six months and finally got it to approve the Botox treatments, but only for two treatments at a time, and only because she has been diagnosed with another condition, cervical dystonia, a chronic disorder characterized by involuntary movements of the neck that are often painful and which exacerbate her migraines.
In her case, the Botox is injected into trigger points in her upper back, neck and shoulders, as well as in the forehead and in the back of her head.
While she is getting the treatments paid for by her insurer, she is hopeful the FDA will approve the use, as she said it would make it easier for her and her doctor.
"Right now, every six months we have to go through the paperwork all over again," she said.
But Dr. Bajwa said the effort is still worth it for hard-to-treat patients such as Profita Orok.
"We save it for patients who don't respond to other therapies and it works for about half the patients we try it on," he said.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted September 2011