The use of botulinum toxin in the treatment of headaches.

Migraine is a disabling condition which affects 28 million Americans. Over 10 million Americans suffer from daily headaches. The discovery of triptans has revolutionized abortive therapy of migraines. However, patients suffering from frequent attacks and those who do not respond or do not tolerate triptans require prophylactic therapy. Many non-pharmacological treatments, such as biofeedback, magnesium and CoQ10 can be effective for some patients. Prophylactic pharmacotherapy of migraine headaches is limited in its efficacy and has a potential for systemic side effects. The use of botulinum toxin for movement disorders and cosmesis led to an accidental discovery of its beneficial effect on headaches. Extensive anecdotal evidence accumulated over the past seven years and controlled trials suggest that intermittent and chronic migraines as well as chronic tension-type headaches may respond to botulinum toxin injections. The effect of a single treatment, which is technically simple to administer, usually lasts three months. Botulinum toxin does not cause systemic or any other serious side effects. Many patients prefer botulinum toxin injections over prophylactic drugs because of its apparently high efficacy and remarkable safety. Several large controlled trials currently underway should lead to a wider acceptance of this treatment by neurologists and pain specialists.