Botox Can Be Effective Against Migraines

Q:  I have had terrible migraines all my life. I have tried everything from Advil to Imitrex, only to find some relief, sometimes. Recently my internist referred me to a specialist, telling me she was concerned I was using too much of the prescription medication Imitrex (I'm taking it nearly every day).

The neurologist wants to try Botox injections, but I'm nervous about this. He says Botox limits the range of facial expressions, particularly around the eyes. I'm an actress, and as much as I'd rather not have my wrinkles (I'm 46), I need my facial expressions more! Should I try the Botox?

A:  The Botox specialist at the Medical College of Wisconsin is physician Bernd Remler, a Professor of Neurology and a headache expert. He often suggests Botox for people exactly in your situation: intolerable headaches inadequately responding to the usual medications (such as over-the-counter ibuprofen and prescription "triptans").

For people with migraines that are difficult to control, Remler estimates that Botox injections prevent headaches about 50% of the time. When it works, he sees a dramatic benefit. Unfortunately, the effect lasts only three to five months, and so responders need the injections two to three times per year.

Botox gets its fame from its ability to reduce the appearance of wrinkles. Botox literally paralyzes the muscles it comes in contact with. So, it can reduce frown lines (the wrinkles between your eyebrows) but it also limits your ability to furrow your brow. Additionally, your eyebrows and lids may sag and make it more difficult to express joy or show surprise.

You may wish to give Botox a try while maximizing your chances to maintain your facial expressions. Remler recommends choosing a physician with significant Botox experience, because the effect depends on the exact location of the injection as well as its depth. For you, he would start with a lower dose, using fewer injection sites and avoiding the eyebrows and eyelids.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.