New York Headache Center

Botox is effective for chronic migraines, according to a statement released by Allergan, maker of Botox.  The company reported that a large multi-center trial (the New York Headache Center was one of the trial sites) yielded positive results.  This report did not surprise us or our colleagues who routinely use Botox in treating patients with chronic migraines.  The excitement we feel is due to the fact that many of our colleagues have been skeptical about the efficacy of Botox.  Much more importantly, we hope that this definitive study will compel insurance companies to pay for this treatment.

Cluster headaches cause the worst pain imaginable, leading some patients to thoughts of suicide.  They occur in about 0.1% of the population, while  migraine headaches afflict 12%, which may explain why so much less research has been conducted on cluster than on migraine headaches.  Injectable sumatriptan (Imitrex) is the only drug approved by the FDA for cluster headaches.  We do use many other medications “off-label” for both acute and prophylactic treatment, but none have been subjected to rigorous research.  That is none, until recently - zolmitriptan nasal spray (Zomig NS) has been shown to be effective in relieving cluster headaches within 30 minutes.  While the dose of Zomig NS for migraines is 5 mg, in this latest trial both 5 and 10 mg dose was studied.  The 10 mg dose was better than 5 mg dose in patients with episodic cluster headaches (74% vs 52%), but these two doses were equally effective in patients with chronic cluster headaches (41% vs 42%).  The advantage of Zomig NS over Imitrex injection is that it is easier to use and does not involve a painful injection, while the advantage of Imitrex is that it works faster.  Zomig NS is now approved for acute treatment of cluster headaches in Germany, Netherlands and Denmark.

Children with thyroid disease are more likely to have headaches, according to a study done by Dr. David Rothner and his colleagues at the Cleveland Clinic.  36% of children with hypothyroidism and 19% with hyperthyroidism had headaches.  The types of headaches observed included chronic migraine and new daily persistent headache.  The authors conclude that thyroid testing should be part of a standard evaluation of headaches in children, just like it is in adults.

Women with menstrual migraines who also have chronic migraines can be successfully treated with hormonal therapy, according to a study by Drs. Calhoun and Ford published in journal Headache.  Surprisingly, controlling menstrual migraines led to improvement in chronic migraines as well.  Chronic migraine is defined as a headache with migraine features that occurs on more than 15 days each month and it affects a staggering 4%-5% of the population.   Hormonal therapy usually consists of taking an oral contraceptive continuously for many months, thus eliminating menstrual periods and often headaches and PMS symptoms.  Oral contraceptives should not be taken by patients who have visual aura - visual disturbance that usually lasts 30 minutes and precedes the headache.