Freedom of Expression, Indeed!!

“A preliminary study suggests the same type of botulinum injection used for cosmetic purposes — Botox — may be associated with reduced frequency of migraine headaches that are described as crushing, vicelike or eye-popping (ocular), but not pain that is experienced as a buildup of pressure inside the head, according to a report in the February issue of Archives of Dermatology, one of the JAMA/Archives journals” (see press release here).

This caught my attention because (1) this study was supported in part by a grant from Allergan Inc., the company that markets Botox, (2) co-author Dr. Burstein serves as a consultant to Allergan Inc. and receives honoraria for lectures and grants for clinical and animal research, and (3) the authors admit how difficult it is to demonstrate that Botox is more effective than placebo for treatment of migraine headaches.

Regarding the latter point, the authors write: “The initial promise of a new prophylactic [preventive] therapy for migraines was met by the challenge of replication of these results,” as subsequent studies have failed to demonstrate botulinum was more effective than placebo.

Sounds like the end of the road for Botox as a treatment for migraine. But wait! The authors acknowledge that “researchers have searched for patient characteristics that may predict a favorable treatment response.” In other words, let’s find some migraine patients for whom Botox works.

According to this study, Botox may be effective in the treatment of “imploding” or “eye-popping” headaches but NOT “exploding” headaches. Among all participants who responded to treatment, patients with exploding headaches experienced an average reduction in migraine frequency of 11.4 to 9.4 days per month (ie, not much improvement), whereas frequency in participants with imploding or ocular headaches reduced from an average of 7.1 days per month to 0.6 days per month.

“These preliminary data are intriguing, and our results provide support for the hypothesis that patients with migraine that is characterized by imploding and ocular headaches are more responsive to botulinum toxin type A than those with migraine characterized by exploding headaches,” the authors write. “Our findings invite consideration of using botulinum toxin type A injections to prevent migraine headaches and may promote the role of the dermatologist in the treatment of patients with migraine. However, well-controlled trials need to be conducted to confirm these findings.”



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