Botox is approved for chronic migraines

Botox was just approved by the FDA for the treatment of chronic migraine headaches.  This is great news to the more than 3 million chronic headache sufferers in the US (people who have more than 15 days with headaches each month).  In Dr. Mauskop’s opinion Botox is one of the most effective treatments for frequent and severe headaches and it is the first treatment approved FDA for chronic migraines. Dr. Mauskop was one of the first headache specialists to begin using this treatment more than 15 years ago. He has published several scientific articles and book chapters on the use of Botox for headaches. His most recent chapter on Botox for headaches was just published a month ago in the 97th volume of the Handbook of Neurology (Elsevier).  Dr. Mauskop has trained over 200 doctors from all across the US, Canada and Europe who traveled to the New York Headache Center to learn this technique.  Initial reports of the use of Botox for headaches were met with disbelief, while strong skepticism about the efficacy of this treatment persisted for many years. The main reason for this skepticism was the fact that migraine headaches are known to originate in the brain, while Botox affects only muscles and nerves on the outside of the skull. A large amount of research led to our current understanding of how Botox works: while the brain begins the headache process, it requires feedback from nerves and muscles on the surface of the head. By blocking activation of the nerves and muscles the feedback loop remains open and the headache does not occur. After the first few treatments some patients still develop a migraine aura or just a sensation that the headache is about to start, but it does not. After repeated treatments even the auras and this sensation stops occurring. Botox seems to be effective in 70% of patients, which is a rate significantly higher than with any preventive migraine medications, such as Topamax (topiramate), Depakote (divalproex sodium), Inderal (propranolol), or Neurontin (gabapentin). These drugs are effective in less than 50% of patients who try them. The other 50% do not respond or develop unacceptable side effects. Lack of serious side effects is another big advantage of Botox over medications. Botox can cause cosmetic side effects, such as a surprised look, droopy eyelids, or one eyebrow being higher than the other. These and other side effects become less common as the doctor who performs them becomes more experienced. Occasionally, patients develop a headache from being stuck with a needle. This is also uncommon because the needle is very thin and if done correctly, the procedure usually causes very little pain. The effect of Botox begins about 5-6 days after the injections, but the improvement continues to occur for 3 months, at which point the second treatment is given. Some patient require Botox injections at 2 month intervals. Published studies have shown that the second treatment is usually more effective than the first and the third one is better than the second. After several treatments some people improve completely (a small percentage of patients stop having all of their headaches after the first treatment). Dr. Mauskop’s experience suggests that children as young as 10 who suffer from daily headaches also respond well to Botox injections. The major drawback of Botox is its cost. However, several insurance companies have been paying for this treatment and with the FDA approval most of them will have to cover this treatment for patients with chronic (more than 15 days a month) headaches.

  1. cbusnitz says: 09/26/20117:37 pm

    It will be interesting to see if this treatment works. I have not suffered from migraines but I recently saw a few stories on news mags like The Journal with Joan Lunden and CNN that were talking about the number of people who deal with chronic migraines and the effects it has on their lives. It sounds horrible. Hopefully this treatment will have the capability of helping some people.

  2. Kourtney says: 01/27/20116:43 pm

    Lauren, I wonder if you have seen this document from United Healthcare

    It states what needs to be proven in order to get this covered. Mainly, you must be having migraines more than 15 days in a month, lasting for more than 4 hours. They also make you prove that you have tried at medications from all the different categories (beta-blockers, etc) all the way up to the max doses with no good results. If you don’t get migraines with that frequency or haven’t tried all the other options yet you will have to do those first. But if your doctor writes to them covering all those points proving that you need botox as a last resort, you may have some good luck.

    I have had migraines since i was 5 years old (i am 26 now) and on a frequency of about 20-25 days per month. (this is also commonly called daily chronic headache associated with migraines) and my doctor was able to get my health insurance to cover the cost before it was FDA approved. It has been the only treatment that has given me relief, and have been having great results for a year and a half now. Good luck, as i will most likely be getting United Healthcare very soon and hope to be able to continue my treatment.

  3. Lauren says: 11/03/20103:24 pm

    This is great news but unfortunately United Healthcare still refuses to cover it even though the FDA passed it. They still say it’s in a experimental stage.

  4. Cathy Engdahl says: 10/16/201012:35 pm

    This is GREAT news. I was very lucky to have Dr. Mauskop give me my Botox shots. Due to insurance restrictions by Blue Cross, I had to stop the Botox which resulted in my migraines to become so frequent and debilitating that I am now on disability and unable to work. I consider the FDA approval a true blessing for chronic migraine sufferers and want to thand Dr. Mauskop in his unrelentless pursual to provide his patients with a treatment he KNEW would help and now the FDA approves with him.

    Thanks Dr. M!!!

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