I know I’ve said it before, but BOTOX ® really is the new aspirin. In early October Allergan (makers of BOTOX®) announced that the FDA approved BOTOX ® for use in treating chronic migraine patients (defined as 15 or more migraine days a month). Many patients are eager to try a new treatment because in addition to pain they typically experience dizziness, nausea, vomiting, sensitivity to light and noise, and sometimes even vomiting. Now that the drug is approved, Allergan is free to market BOTOX as a treatment for migraines (even though it has been used off label for this purpose since 1992), leading some analysts to predict that its therapeutic use will eclipse the cosmetic. Of course, this will also depend on whether insurance companies will cover the treatment.
Just for some background, BOTOX ® is produced by purifying proteins from the bacteria that causes botulism (an illness mainly characterized by paralysis). The cause of some migraines is thought to be pressure on nerves in the neck and head from muscle use. BOTOX ® is used to treat migraines by injecting the frowning muscles found in the forehead, chewing muscles in the temple and others in the neck and shoulders. This leads to relaxation of the muscles, as well as a decreased muscle volume, relieving pressure on the nerve. As an added bonus these patients will have fewer wrinkles. The treatment will wear off and need to be re-administered approximately every 3 to 6 months.
It is yet to be seen whether BOTOX ® treatments will be covered by insurance companies for this approved use, so a recurring out of pocket treatment may be cost prohibitive for some patients. For those seeking an alternative, muscle pressure may also be relieved surgically. Nerves in the forehead run through a tight ring of muscular tissue that can be released via an incision hidden behind the hairline or in an upper eyelid crease to decrease pressure on the nerve (this is actually similar to the procedure performed in the wrist to treat carpal tunnel syndrome). In recent studies the treatment was successful in about 92% of the cases (35% reported elimination of the pain, 57% experienced significant reduction in headache episodes).