A New Wrinkle in Headache Treatment
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Headache sufferers are finding relief from migraines from an unexpected source. Botox®, the drug best known for reducing wrinkles, is being used to treat headaches. Physicians believe that the drug reduces headache pain because it reduces muscle contractions or blocks a pain-transmitting chemical, or through a combination of both actions.
Wayne T. Cornblath, M.D., neuro-ophthalmologist at the University of Michigan Kellogg Eye Center, says that many of his patients are relieved to find that Botox makes their once debilitating headaches manageable.
Mary Anne Brancheau is one such patient who characterizes the treatment as "life altering." Now that the injections are working, she realizes the magnitude of the pain, frustration and fatigue that accompanied her daily headaches. "I tried other medications for years, but nothing really worked. Before, I'd describe my quality of life as mediocre; now I'm productive again, and I'd classify the quality of life as a ten," she says.
Doctors discovered this new use for Botox just a few years ago, when patients reported fewer headaches after receiving injections to reduce wrinkles. Several clinical trials followed, and in June 2002 researchers at the annual meeting of the American Headache Society reported on a study of 134 individuals, most of whom, like Ms. Brancheau, had little success with conventional medications.
Some 84 percent said that Botox had lessened the pain from their migraine, tension, or chronic daily headaches. Cornblath says that he sees a similar success rate in his own practice. "In my experience, about one-third of my patients have had complete relief from headaches, and another one-third have found partial relief," Dr. Cornblath observes.
To treat headaches Cornblath administers approximately 10 injections, five in the forehead and five in the back of the neck. The small dose and location of the injections help to minimize side effects, which are generally limited to a slight decrease in ability to move forehead muscles or elevate the eyebrows.
According to Cornblath, "The side effects are negligible, especially when compared to those associated with some of the stronger migraine medications."
The injections take from 1 to 14 days to have an effect, and the benefits last from 2 to 5 months.
For more information, contact the Eye Plastic and Neuro-Ophthalmology Clinic at the U-M Kellogg Eye Center, 734-763-9142.
Beyond Botox
Innovative treatment options, such as Botox injections to remedy headaches, are continually being investigated. The National Headache Foundation reports that a number of new headache treatments are in the research and trial phases.
* Generics: Oral and intranasal generic sumatriptan are expected to be available in 2008 and 2009, respectively (Ranbaxy Pharmaceuticals, Inc. and NovaDel).
* Inhalation device: Uses heat to vaporize a drug into an odorless mist that passes through the lungs into the bloodstream. The hope is to provide relief within 60 seconds. The device is currently in clinical trials using prochlorperazine (Staccato® from Alexza Molecular Delivery Corp.).
* Skin patch: The system uses a transdermal patch containing the drug and a small battery-powered electronic controller that precisely controls the rate and amount of drug released from the patch. A patch is currently in clinical trials using zolmitriptan (Actyve® from Vyteris). A sumatriptan transdermal patch based on proprietary SmartRelief™ iontophoretic patch technology is in development. (NuPathe)
* Nasal powders: A powder form of dihydroergotamine is being studied. Currently administered as a nasal spray, the powder form may be easier to use and more rapidly absorbed. (DHE Nasal Powder from Britannia Pharmaceuticals in collaboration with Novartis Pharmaceuticals)
* New drug combination: A combination of sumatriptan and naproxen sodium that provides faster, sustained pain relief compared to each individual medication is expected in 2008. (Trexima® from Pozen Inc. in conjunction with GlaxoSmithKline).
For more information on the latest headache treatments in development, or tips for coping with headaches, visit www.headaches.org.