Just a few days after new migraine treatment guidelines were released at the American Academy of Neurology's annual convention, new research published in this week's edition of JAMA, finds Botox may not work as well on migraines as originally thought.
The AAN's recommendations found that numerous drugs, such as the seizure drugs divalproex sodium, sodium valproate and topiramate, along with the beta-blockers metoprolol, propranolol and timolol, are effective for migraine prevention.
The guidelines also noted herbal drugs such as petasites relieved migraine pain and nonsterodial anti-inflammatory drugs, such as ibuprofen and naproxen sodium should be offered to people with migraines to reduce the frequency and severity of attacks.
Botulinum toxin A, otherwise known as Botox, was not mentioned.
Since Botox has become a popular way to eliminate wrinkles in the forehead, doctors have been using it for all types of treatments, from excessive sweating to headaches. But even though the U.S. Food and Drug Administration has approved botulinum toxin A injections for the prevention of chronic migraines, a new analysis finds Botox provides only a small to modest benefit for patients with migraine or daily headaches.
The review states that migraines and tension headaches are extremely common, about 42% of adults in the U.S. experience a tension-type headache sometime in their lives. But many of these headache sufferers don't seek medical help. Migraines are less common - about 8 to 18% of the population suffers from these types of headaches, which are far more debilitating.
Botulinum toxin A injections were first proposed as headache treatments when doctors noticed patients with chronic headaches receiving cosmetic Botox injections also found relief for their headaches. Studies on botulinum effectiveness for headaches have been mixed.
Researchers from the Medical College of Wisconsin, Milwaukee, reviewed previous studies on botulinum toxin A when used for the treatment of migraine, tension or chronic daily headaches in adults. The headaches were categorized as episodic (less than 15 headaches per month) or chronic (15 or more headaches per month), migraine and episodic, or chronic daily or tension headaches.
The researchers reviewed 27 randomized placebo-controlled trials that included a little more than 5,000 study participants and four randomized Botox comparisons with other medications for migraines and chronic headaches.
They found Botox was associated with approximately three fewer headaches per month among patients with chronic daily headaches and among patients with chronic migraine headaches, about two less per month.
There was no significant association between the use of Botox and reduction in the number of episodic migraine or chronic tension-type headaches.
And compared with those on a placebo, Botox caused users to have side effects such as drooping of the upper eyelids, skin tightness, a tingling sensation in the injection area, neck stiffness, muscle weakness and neck pain.
When compared to other drugs, Botox did not prevent chronic migraine headaches any better than drugs like topiramate or amitriptyline.
According to the study authors, "Our analyses suggest that botulinum toxin A may be associated with improvement in the frequency of chronic migraine and chronic daily headaches, but not with improvement in the frequency of episodic migraine, chronic tension-type headaches, or episodic tension-type headaches. However, the association of botulinum toxin A with clinical benefit was small."