A treatment commonly used by dermatologists to get rid of facial wrinkles may
also help migraine sufferers, a UCSF researcher has reported.
In a presentation at the American Society of Dermatologic Surgery meeting (held
November 2-5), Richard Glogau, MD, UCSF professor of dermatology, reported that
75 percent of patients in his case study experienced four to six months of
migraine relief following injections of Botox (botulinum toxin A derived from
bacteria) to muscles of the face and head. Glogau’s small study of 24 patients
adds weight to previous reports that botulinum toxin A can relieve headaches.
Since 1992, Botox, the same bacteria that causes deadly food poisoning, has
been used in purified and diluted form to temporarily paralyze the muscles that
bring the eye brows together, thereby eliminating wrinkles in this region.
Since then, it has also been used to mitigate wrinkles in the forehead and near
the eyes and mouth. Patients in Glogau’s dermatology practice injected with
botulinum toxin A in the upper third of the face for treatment of cosmetic
frown lines (who coincidentally suffered from migraine headaches) have reported
the added benefit of headache relief, he said.
Following this serendipitous discovery, Glogau and other researchers began to
evaluate injection points and dosages that could alleviate headaches. Glogau’s
results indicate that botulinum toxin A injected into the muscles of the brow,
eyes, forehead, side of the head and back of the head near the neck (a point
that earlier investigators have neglected) induce sometimes immediate headache
relief and provide benefit for up to six months, he said. Botox dosage in his
case studies averaged 80 units per patient.
Though the mechanism for migraine relief is not known, Botox injections
paralyze the muscles in the face and head. Botulinum toxin A may stop the
expression of pain by stopping muscle contractions that lead to spasm, he
explained, or it may inhibit nerves that transfer pain responses to the brain
and spinal chord. In all likelihood, it does both, he said.
There are no published, randomized, double-blind trials that show the safety
and efficacy of Botox for treatment of migraines, Glogau said. In fact, most of
the data consists of case reports and meeting abstracts. Two previous studies
were presented at the 1999 meeting of the American Association for the Study of
Headache. In the first study, reported by researchers at the Michigan Head Pain
and Neurological Institute in Ann Arbor and Michigan State University, a
one-time dose of 25 units of botulinum toxin A injected into the muscles of
the brow, forehead and side of the head, reduced the frequency of migraines,
the severity of pain, vomiting, and the use of pain medications for up to three
months. A 75-unit treatment yielded headache relief, but also side effects like
eyelid drooping. In another study, reported by researchers at the University of
California, Los Angeles, 51 percent of 96 patients reported complete
improvement of their migraine pain.
“It doesn’t work on everyone and it doesn’t work on all headaches,” said
Glogau. However, when physicians start with injections into the eye brow area
(the same method used by dermatologists to treat wrinkles) and work toward the
back of the head, the response rate appears to be higher, he explained.
Glogau also noted that higher dosages of botulinum toxin A administered with
increasingly improved technique may be critical to migraine relief. “Too much
drug in one spot and too close to the eye rim affects muscles of the eye,
causing drooping,” he explained.
Patients successfully treated in Glogau’s case studies had long-standing
diagnoses of migraines, had all seen neurologists, and were taking standard
migraine medications, including sumatriptan (Imitrex). Some required narcotic
medication to relieve the pain of their frequent headaches. Most suffered
migraines on a minimum of once a week and several suffered on a daily basis.
In addition to use in prevention of wrinkles, Botox has been used to treat
uncontrolled eye twitching, crossed eyes, muscle spasms and, most recently,
excessive underarm sweating (reported by Glogau in the September, 1998 issue of
One limitation for botulinum toxin’s use in treating migraines is cost. Unlike
other treatments for migraines, such as the prescription drug Imitrex and nasal
sprays, Botox injections are not covered by insurance and cost about $350 for
each targeted area.
Glogau is a consultant to Allergan, the Irvine, California company that
manufactures Botox. He does not own stock in the company.