Toxin Offers Relief From Migraines

Sept. 28 1999
Allan Sison
Medical Tribune

Researchers have found that Botulinum toxin type A can be used to prevent, as well as treat, migraines with minimal side effects. The toxin, also know as BOTOX (Allergan), is commonly used by ophthalmologists and neurologists to treat certain eye and neurologist disorders. The toxin has also recently been used in cosmetic surgery to smooth wrinkles.

Dr. William Binder, a facial plastic and reconstructive surgeon at Cedar-Sinai Medical Center and assistant clinical professor at University of California, Los Angeles, found that the toxin could be used to treat headaches while testing its effects on wrinkles in 1992. He called it “a serendipitous finding,” since he discovered the protein’s migraine-fighting effect by accident.

In the migraine treatment, BOTOX is injected into muscles of the forehead to paralyze them. The BOTOX was injected in the forehead at the glabellar, temporalis, frontalis and suboccipital regions of 100 patients, average age 44. Of the 100 patients, 75 had been diagnosed with true migraine, 15 as possible migraine sufferers and seven had “nonmigraine” headaches.

The treatment resulted in complete headache relief for more then 50 percent of patients In some cases, relief lasted as long as three to four months.

Binder and colleagues presented their finding at the American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting and Oto Expo in New Orleans, L.S., held September 26 to 29. “It’s not going to work on everyone,” Binder said in an interview. “But we have a pretty good response.”

Migraines are characterized by massive head pain, nausea, and heightened sensitivity to being near light. In the United States, 17 percent of woman and six percent of men suffer from migraines. Current treatments for migraine sufferers provide relief that lasts for several hours at most.

Botulinum toxin type A comes from the bacterium that causes botulism, Clostridium botulinum. Before being used in plastic surgery and neurological treatments, the toxin is first isolated from the bacterium.

Binder presented his finding to Allergan in Irvine, Calif., in 1997. The company conducted a double-blind study that ended at the beginning of this year. Not only were they able to replicate Binder’s results, but they also discovered that it was possible to achieve even better results at lower doses.

“Most of [the current treatments] are oral medications,” said Dr. Elizabeth Loder, director of the headaches management program at the Spaulding Rehabilitation Hospital in Boston, Mass. She noticed that many of these drugs have unintended adverse side effects.

Current treatments generally act to neutralize the migraine once it has taken place. “BOTOX is meant to be used to prevent headaches,” said Loder.

Because the toxin paralyzes muscle, she said, treatment with BOTOX may lead to side effects if the toxin is not injected into the right location. However, she added that “It’s fair to say that the side effects are minimal and very well tolerated.”

Unfortunately, it looks like FDA approval is in the far future. “We’re in the early-to-mid stages of development of the drug for migraines,” Loder said.

“The dosing is yet to be decided,” said Binder. Further trials are planned to establish dosing, replicate results, and to determine the toxin’s effects on specific muscle groups.

C. 1999 medical Tribune News Service