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Beyond cosmetic aid, Botox potent weapon against migraines

Nancy Buckley couldn’t believe it.

After years of taking a variety of medications that only occasionally helped relieve the symptoms of almost daily migraines — blinding and dizzying headaches so severe she compared the pain to what a knife thrust behind the eyes must feel like — her neurologist said she might be a good candidate for Botox injections.

At first, Buckley thought she heard wrong, wondering why this was a time to worry about smoothing out frown lines.

It was just before Christmas and her head throbbed. As she so often did, she saw spots before her eyes.

“I have complete faith in Dr. (M. Gabriela) Gregory, so I went along with them,” the 50-year-old Buckley said prior to Gregory giving her a second series of 31 Botox injections in early March at the Nevada Neurosciences Institute at Sunrise Hospital. “I found for awhile the injections really helped, but they came back before I could get this next treatment.”

It turned out that what Buckley thought was used only for cosmetic purposes had been approved in 2010 by the Food and Drug Administration as a treatment for people who suffered chronic migraines— 15 or more headache days a month, with each lasting four hours or more.

“Many people still haven’t heard about using Botox injections for migraines,” Gregory said. “I’ve had 75 percent success rate using Botox when it comes to patients having fewer headaches. But you have to be very selective in using it. You have to make sure no other illness is causing the headaches and it helps that patients improved some on other medications before you use it. Botox is like a haircut that grows out. Its effects wear off and and patients know it’s time for more.”

In the mid-1990s, physicians noted that patients reported fewer headaches after they had received Botox injections for forehead wrinkles. Clinical trials ultimately found that Botox prevented up to nine headache days a month, which led the FDA to approve Botox as a treatment for migraines, with physicians able to safely inject patients every 12 weeks at 31 sites in the head and neck area.

What makes migraines different from other headaches is that the pounding pain is frequently accompanied by nausea and vomiting. Most sufferers recover in a dark, quiet room because migraines are exacerbated by noise and light. People who suffer from them say that calling them “just another headache” is like calling a hurricane “just another storm.”

Just as researchers aren’t sure as to what causes migraines, clinicians still aren’t sure why Botox works in relieving the chronic headaches for some people.

One theory holds that it may block nerves that carry pain messages to the brain or may actually block certain chemicals that contribute to migraines.

Made from a toxin produced by the bacterium Clostridium botulinum — the same toxin that causes a life-threatening type of food poisoning called botulism — Botox is a drug not only used in small doses by doctors for cosmetic purposes and chronic migraines, but also for conditions that include overactive bladder, misaligned eyes, uncontrollable blinking, severe neck and shoulder muscle contractions and severe underarm sweating.

While scientists aren’t clear as to why Botox sometimes is effective on migraines, Botox injections have worked on other conditions for up to 12 months by paralyzing or weakening certain muscles or by blocking certain nerves.

With Buckley sitting on a stool in the middle of a treatment room, Gregory carefully, but quickly, carries out the Botox injections with needles as thin as those used to deliver insulin — a few to the forehead, others around her skull.

Ten minutes after she begins, Gregory is done.

“It felt like bee stings,” said Buckley.

Migraines, which stem from the Greek word Hemikrania, or “pain on one side of the head,” have plagued many notable figures down through history, including Thomas Jefferson, Sigmund Freud, Virginia Woolf, Elizabeth Taylor and Elvis Presley. Doctors say more than 30 million Americans suffer from them.

Why migraines occur is not fully understood. But most researchers believe they’re due to abnormal changes in levels of substances naturally produced in the brain. If the levels of the substances increase, they can cause inflammation, which then causes blood vessels in the brain to swell and press on nearby nerves, causing pain.

After doctors diagnose someone with migraines, a variety of medications may be used, including over-the-counter pain medications and drugs that constrict blood vessels in the brain and relieve swelling. Certain blood pressure medications as well as antidepressants and antiseizure drugs may also be given in an effort to prevent the headaches.

“We know,” Gregory said, “that there is often a family history of migraines … and that these headaches are related to electrical disturbances in the brain.”

For those prone to migraines, Gregory said they learn to avoid dietary triggers such as chocolate, red wine, and preservatives such as MSG, which is often used in Chinese food.

Not getting enough sleep and high stress are other potential triggers.

To date, Gregory said, no medication or behavior modification can completely prevent migraines, though the number of headaches and severity of symptoms have been lessened for many people through treatments.

She said she is hopeful that FDA approval in mid-March of a nerve-stimulating headband to treat migraines will give her yet another tool to help patients. Called the Cefaly, the battery-powered band is supposed to stimulate branches of the trigeminal nerve, which has been associated with migraine headaches. A clinical trial in Europe showed that those who use the device spent fewer days battling headaches.

“We need to use what can help patients,” she said.

According to studies, people with multiple sclerosis or MS, which Buckley said she was diagnosed with three years ago, seem to be more prone to migraines. MS is a chronic, progressive disease involving damage to the sheaths of nerve cells in the brain and spinal cord, with symptoms that can include impairment of muscular coordination.

“We don’t know how much of a role the MS plays in the migraines, if any,” Buckley said.

Tracey Brierly, a former Clark County chief deputy district attorney who had to go on disability three years ago because of frequent migraine headaches that caused severe pain and vomiting, had no underlying illness when the headaches that first began in law school progressed to the point that they became disabling.

A patient of Dr. Abraham Nagy, she, too, has been helped by the Botox injections which she says can cost up to $3,000 a session — a cost she said is largely covered by insurance.

“It’s reduced the number of my headaches, but it wears off before I have to go back,” she said. “This illness has stripped me of my identity of being a lawyer. I want to go back to work. I wish I could tell you that Botox makes them leave entirely. But I can’t.”

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.

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