Botox Gains Traction in Treating Chronic Migraines After Study Presented in May

By Lauren Mazzo and Sally Young.

Walking into a room with bright lights; texting on her iPhone; inhaling a spritz of perfume; being surrounded by loud music: each of these everyday occurrences has set off a migraine for Rebecca Plotkin, 18-year-old Ithaca College student. Her only relief has been a treatment commonly used by older women looking to stay young: Botox.

Plotkin is one of about 3.2 million Americans suffering from chronic migraines–intense headaches that can last four hours or longer during at least 15 days of the month. There are several drugs used to curb or prevent migraines, like Cymbalta, Elavil, and Topamax. The US Food and Drug Administration first approved the use of onabotulinumtoxinA, or Botox, as a chronic migraine treatment in 2010.
“Botox is a very effective treatment for a significant percentage of patients, and for some patients it actually can lead to quite a dramatic improvement,” Dr. Audrey Halpern, neurologist and headache specialist at the Manhattan Center for Headache and Neurology and Plotkin’s doctor, said.

In May 2014, Dr. Andrew M. Blumenfeld, from the Neurology Center of Southern California, presented his study which tested the effectiveness of Botox as headache treatment at the American Pain Society 33rd Annual Scientific Meeting. For the study, chronic migraine patients were treated with Botox over the course of 21-27 months. At baseline, the 33 adult patients suffered an average of 19 migraine headaches in a span of 30 days, while those who received cycles of Botox treatment experienced an average of six headaches over the same time period.

“I think it’s the most effective of all the treatment options,” Blumenfeld said. “I do about twenty injections a day.”

Halpern said that while she has been using Botox as a treatment since 2002, it has been used much more frequently since the FDA’s approval, especially in the last year. She said that the way Botox relieves migraines has not been completely worked out.

“What we believe is happening in migraines is that the Botox actually gets into the nerve that mediates migraine as well and prevents the release of chemical messengers that propagate migraine pain signals.”

“It’s a really great option for a lot of people because you don’t have to take a pill everyday; you come every three months for the treatments, there are very few if any side effects, there are no drug interactions,” she said.

Plotkin started experiencing chronic migraines after receiving two concussions in the same year, and tried both holistic remedies (diet, exercise, meditation) and prescription drugs before receiving approval to undergo Botox treatments.

“A lot of the treatments give you worse headaches. I was having a migraine pretty much every day and at first I was just taking Advil and Aspirin, which doesn’t really help,” Plotkin said. “When you have such frequent headaches, it’s really hard to manage.”

Rachel Kern, 21-year-old Ithaca College student, is also diagnosed with chronic migraines. Before she started taking the preventative drug Topamax, she would have daily migraines that were “debilitating.”

“I used to throw up,” said Kern. “I couldn’t focus in class and my eating habits got thrown off because of it. I tried different remedies and nothing helped.”

Because of the many possible side effects associated with Topamax–for example, numbness, fatigue and taste change–Kern said her parents were wary of letting her start the drug. But her migraines were too severe to continue without taking a preventative medication. Though she said her neurologist never proposed Botox as an option, “if nothing else worked I would try it.”

Botox was a disputed treatment until the October 2010 study that prompted the FDA’s approval. The study, conducted by Sheena K. Aurora at the Swedish Pain and Headache Center, demonstrated the treatment’s effectiveness after six to eight months of injections, while Blumenfeld’s study aimed to test long-term success.

Plotkin began Botox treatments in July, and said she’s already seeing an improvement.

“Last week, I went a full week without getting a migraine,” Plotkin said. “It definitely makes me optimistic. It’s not going to solve my problem, but it’s helping it.”

See this story on Ithaca Week.

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