Two large studies confirm that Botox is effective for chronic migraine

It is very exciting to finally have two published studies (PREEMPT 1 and PREEMPT 2) which provide definitive proof that Botox is effective for chronic migraine headaches.  More than 15 years ago a plastic surgeon in California, Bill Binder reported that many of his patients treated with Botox for wrinkles found relief from headaches.  Everyone was very skeptical, but having many patients who failed every other treatment and having learned that Botox is very safe if used properly, I decided to try it.  To my great surprise Botox worked exceptionally well.  My most dramatic experience was in a 76-year-old woman who suffered from daily headaches for 60 years.  She had failed a long list of medications, nerve blocks, acupuncture and other treatments.  After the first Botox treatment, for the first time in 60 years she went for three months without a single headache.  Her neurologist came to my office to learn the technique I developed and has been using Botox in his practice ever since.  More than 200 doctors from around the world came to our Center to learn how to use Botox for headaches.  They were all searching for new treatments for their desperate patients.  At the same time most of the medical community had remained very skeptical and dismissive of this approach.  They could not believe that Botox could help headaches and wanted to see double-blind, placebo-controlled trials before using it in their patients.  Well, now they have it, but over the past 15 years many of their patients could have benefited from this safe and effective treatment.  Yes, we do need proof that any new treatment works, but when this treatment is safe and there are no better alternative, it is appropriate to try it before definitive proof is available.  We hope that these two studies will lead to the FDA approval of Botox for the treatment of chronic migraines before the end of 2010, which will make it easier for patients to obtain insurance reimbursement.

15 comments
  1. M. Gonzales says: 03/19/20104:04 pm

    The question is, on what percentage was the treatment successful?

  2. Dr. Mauskop says: 03/20/20104:59 pm

    Botox works for about 70% of patients with chronic migraine headaches. It appears to work even for people with rebound (medication overuse) headaches. And, of course, it works for people who think they have chronic sinus headaches because most of them have chronic migraines. It’s important to try Botox two or three times in a row since each subsequent treatment has been shown to provide better relief than the previous one. So, if the first one gives minimal relief, the next one may be better and the third one better still. A small percentage of people obtain complete relief of all of their headaches after the first treatment.

  3. Beth Gooden says: 03/29/201012:58 pm

    As a chronic migraine sufferer for the last 14 years and have also tried everything with little or no relief, is this something that I will need to do every 12 weeks in order to get results and for how long? Or how long does the effects last once you’ve done the first three treatments? Also, does your staff have experience with the Botox patience assistance program for the uninsured with any of your patients and if so, has if it’s helped those patients get Botox where they wouldn’t have been able to otherwise? I am currently in that financial position but the thought of even a week without a migraine is heaven. Thanks for your valuable time and information!!

  4. Dr. Mauskop says: 03/29/201010:31 pm

    For some patients the first Botox treatment provides complete relief for 3 months, but more often the first treatment is only partially effective – the headaches may be milder or less frequent, or both. The second treatment usually provides better relief and the third is even better than the second. Some people need to continue Botox injections every 3 months for a few years, but for some headaches do not return after 3-5 sessions. Allergan, maker of Botox does provide patient assistance program and we’ve had a few patients who were able to obtain Botox for free.

  5. Jennifer O'Neill says: 04/18/20105:04 am

    I am a 36 year old female who has suffered from chronic migraines for over 10 years. I get between 3 to 4 a week and am currently on disability and unable to work. Actually, I’m not really able to do much of anything. I have worked with many Nuerologists and specialists over the years, taken every preventative medication under the sun, have tried bio-feedback, accupuncture, holistic medicine and basically everything I can get my hands on and can financially afford. I have offered myself up for research studies all with no real sucess. I have kept a migraine diary for almost 5 years. No one seems to be able to help me. Luckily I was able to try Botox through a research study and was given 2 rounds of injections lasting 6 months. I say luckily not because it worked, but because it was free. I was sure this was going to be my answer and yet it wasn’t. I have tried Topamax but it made me literally psychotic. Very scary. I felt compelled to respond to your blog because after reading it I was sobbing. To feel trapped at 36 because of my migraines is utterly unbearable. My quality of life is diminishing and I feel helpless. I have continued to trudge and put one foot in front of the other with little to no sucess. So what is someone like me supposed to do now?

  6. a demaria, md says: 07/26/201011:35 am

    i too have had success with many headache patients with botox but find it almost impossible to get insurance to reimburse; i had heard that the fda was reviewing botox for headaches for approval this month-any word?

  7. Dr. Mauskop says: 07/26/201012:39 pm

    Yes, we expect FDA approval any day now. The two large studies were very positive and included 700 patients in each, so there is no reason for the FDA not to approve it. This will make it much easier getting insurance approval.

  8. Janelle says: 08/30/201012:46 pm

    For the patients who have experienced relief, specifically where is the Botox being injected?

  9. Dr. Mauskop says: 08/30/20105:58 pm

    It is usually injected into areas of pain, usually the forehead, temples, back of the head, jaw, and sometimes neck.

  10. Dawn Gooding says: 05/18/20112:27 pm

    Once Botox is injected and the client has relief of symptoms does the botox generally continue to provide relief with all subsequnt injections?

    Does it at times quit working?

  11. Dr. Mauskop says: 05/18/20114:03 pm

    Yes, if Botox works, it usually continues to work, but occasionally it stops working. It could be due to a new trigger (major stress, hormonal changes, magnesium deficiency, etc) or very rarely due to formation of antibodies to Botox.

  12. Theresa Lopez says: 06/09/20112:00 pm

    I have suffered with migraines since I was 30 yrs old, now 55. I was referred to the only Neurologist that administers Botox for the Kaiser I belong to. He gave the injections to me and then said that I was still using about the same amount of medications and that there was a a study that showed Botox for migraines was only a placebo for most patients. He quit giving them to me. That was two years ago. I have tried numerous times to convince him that the injections did work and to please give me another try. I was told at the time , that the inj would lessen the amount of migraines I would get, not completely take them away. I was receiving good relief but yes I did still have some headaches. Now, he is just being bullheaded and obstinate. I went to ENT because I thought well maybe I am having sinus inf. ENT said no, you are having migraines and a new study came out and it shows botox does help with migraines. My PCP has sent a referral to a Neurologist at another Kaiser, and they declined saying they don’t do third party referrals. My Neurologist says her hands are tied that it is up to this one Neurologists if he wants to give me the injections or not. My PM& R doctor also recommends the botox. I am now working on another referral to another Kaiser. Any suggestions or advice?

  13. i am a life long h.a.sufferer.i am a M.D. says: 06/26/20123:28 pm

    verry promising WORK. I .am a M.D.and have DCH/CTTHA/MIGRANOUS component chronic migraine?who knows?
    I have seen many neurologists to no effect. NECK AND trapezium are big and constant companipn in pain.

    how do I get your help? THANKS

    jaspal chawla M.D.

  14. i am a life long h.a.sufferer.i am a M.D. says: 06/26/20123:33 pm

    i hve terrible h.a. iam a M.D.(not good )

    what are the details to get your help?

    THANKS

    jaspal chawla M.D.

  15. Dr. Mauskop says: 06/27/201211:33 am

    Call the New York headache Center, 212-794-3550 for an appointment.

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