Q. I get migraine headaches about three times per month. Once the headache gets started, it can last all day. I don't like taking medications. I recently heard that Botox injections can help migraines. Is this something I should try?
A. A small study published in the February issue of the journal Archives of Dermatology suggests that injections used to treat wrinkles seem to relieve some types of migraine headaches. The study used botulinum toxin A (Botox). These authors think that Botox might relax muscles and prevent the release of chemicals from muscles that could trigger pain.
At first glance, this sounds appealing. But are there any "wrinkles" in this claim? As you might expect, there are.
The study looked at only 18 people who had migraines and planned to have Botox injections for cosmetic reasons. Of this group, 10 had "imploding" or "ocular" migraines. People say this type of headache feels crushing or eye-popping. The other patients in the study had "exploding" migraines. This type of headache feels like a buildup of pressure in the head. While these terms are descriptive, they are not the standard subcategories of migraine.
The people with imploding migraines showed the most improvement. But others in the study also showed improvement. All received treatment with the active agent in Botox. There was no control group.
The study included mostly women. I notice that their average age was 51. This is a typical age for menopause. It is common during menopause for a migraine pattern to improve for no apparent reason. It is possible that the headaches improved all on their own. It is also possible that the headaches improved because of the power of suggestion.
Other studies have looked at Botox and headaches. In May 2008, the journal Neurology published a review of 11 randomized controlled studies. Experts who reviewed the data concluded this treatment was "probably ineffective" for chronic tension headaches and migraines.
Is there any harm in trying? There certainly could be. Botox paralyzes muscles in the area where it is injected.
It's much too soon to consider Botox an effective treatment for migraine.
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— Mary Pickett, M.D., is an associate professor at Oregon Health & Science University, where she is a primary care doctor for adults. She is a lecturer at Harvard Medical School and a senior medical editor for Harvard Health Publications.