"Botoxâ is becoming one of the main preventive therapies for headache," says Troost, professor and chairman of neurology at Wake Forest, who has treated more than 350 patients with Botox. "When it is effective, the need for daily medications or acute medicines for severe attacks is significantly reduced or eliminated."
Botox, a purified form of the toxin that causes botulism, partially paralyzes muscles for about three months. For headache treatment, it is injected into muscles around the eyes and forehead and sometimes the jaw. For patients whose headaches involve the entire head, additional injections are given in the upper back of the neck and shoulders.
For the study, Troost evaluated 134 patients with migraine headaches, tension headaches or chronic daily headaches (having a headache more than 15 days a month). A majority of the patients had already been treated with at least three headache medications without success.
Patients had from one to four Botox treatments at three-month intervals. After each treatment, they were asked to describe the results using a five-point scale (1:"no improvement," 2:"mild improvement," 3:"moderate," 4:"good," and 5:"excellent effect").
Overall, 84 percent of patients reported improvement. Among those who had four treatments, 92 percent reported improvement with a mean score of 4.3.
"There were significant improvements that appear to be progressive and may also be cumulative," said Troost. "I tell patients that it is important not give up if it has only a mild effect the first time. The second or third time it really seems to work better."
Migraine headaches affect about 17 percent of women and 6 percent of men in the United States. About 5 percent of the population has chronic daily headache.
Troost said that patients with debilitating headaches often do not get results from medications designed to treat acute attacks. As a result, they often misuse over-the-counter and prescription pain medications.
"Overuse of medications for debilitating headaches has been observed in up to 80 percent of chronic daily headache patients," said Troost. "These patients should be considered for preventive therapy."
Troost said Botox can be less expensive and have fewer side effects than many medications used for headache prevention.
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