Botox Migraines

October 22, 2010 Written by JP    [Font too small?]

A news item that received a great deal of attention this past week was the FDA’s decision to approve Botox for the treatment of chronic migraines. This was welcome news for the estimated 12% of the US population who live with this debilitating form of headache pain. But as with all medications, symptomatic relief often comes at a price. The treatment itself requires 31 injections directed at seven specific points in the head and neck. In addition, a number of adverse reactions have been reported in relation to onabotulinumtoxin A. Documented side effects include the possibility of blurred vision, breathing problems, difficulty swallowing, muscle spasms or weakness and neck pain. A recent interview with the actress Dana Delany in Prevention magazine chronicles her own negative experience with cosmetic Botox which resulted in a “huge hematoma” and subsequent muscle and nerve damage in the eye region. (1,2)

I hope that the thousands of migraine patients who will likely try Botox in the coming years will benefit from it and avoid any of the previously noted dangers. But various factors including cost and personal preferences will make this pharmaceutical option unsuitable for many health care consumers. For them, I’d like to present some up-to-date information about several natural alternatives for recurrent migraines.

Acupuncture – A publication in the June 2010 issue of The Journal of Neurological Sciences describes the efficacy of ear acupuncture in the management of unilateral migraine pain. The placement of needles in tender points located on the antero-internal part of the antitragus and the anterior part of the ear lobe resulted in symptom reduction of up to 300%. Other varieties of acupuncture also appear to aid migraineurs. However, the benefits can be inconsistent. To address this problem, Chinese researchers have begun offering detailed guidelines about how to increase the likelihood of treatment success. A recent evaluation of the topic suggests that “The optimal treatment frequency is twice a week with one week rest between the first 10 and the last 10 sessions. Additionally, the duration of one treatment session ought to be 30 minutes, while it is recommended to use about 20 needles in one session. The total duration of an acupuncture treatment should be at least 10 weeks”. (3,4,5)

Biofeedback and Neurofeedback – Various forms of biofeedback including EEG, neurobiofeedback, thermal handwarming and “traditional peripheral” biofeedback have demonstrated benefits in the arena of the non-pharmacological treatment of migraines. A recent examination of 37 migraine patients found that biofeedback reduced headache frequency by 50% or more in 70% of those being treated. Furthermore, the benefits were sustained, on average, for 14.5 months after biofeedback treatment ceased. Not all studies agree that biofeedback is more effective than other forms of stress management. However, some trials affirm that biofeedback not only reduces headache symptoms, but may also address some of the underlying psychological triggers such as anxiety. (6,7,8)

Ginkolide B Complex – Two recent Italian studies report that a blend of ginkgo biloba extract and select nutrients can significantly reduce migraine frequency in children in a safe manner. Both open-label trials took place over a 3 month period and employed a dosing schedule of “Ginkgolide B 80 mg, coenzyme Q10 20 mg, vitamin B2 1.6 mg, and magnesium 300 mg in oral administration twice per day – in the morning and in the evening, with meals”. Not surprisingly, the young patients required lesser quantities of pain relieving medication while using the Ginkgo-based dietary supplement. Previous experiments have identified plausible pathways by which Ginkgolide B may exert its pain relieving activity. What’s needed now are carefully controlled studies that compare this natural remedy vs. a placebo. (9,10,11)

Biofeedback May Reduce Migraine Relapse
Source: Cleveland Clinic Journal of Medicine July 2010 vol. 77 (link)

There’s hardly a shortage of alternative and complementary therapies available for migraine relief. A series of scientific summaries from June 2010 offer up the following list of viable options: diet and lifestyle changes, herbal remedies (butterbur and feverfew), nutritional supplements (alpha lipoic acid, CoEnzyme Q10, magnesium and riboflavin) and relaxation training. Most of the studies on natural remedies have examined specific practices or supplements. But one of the more interesting trials of late evaluated the effects of a combined approach. It incorporated Ayurvedic (traditional Indian) “medicines” along with a “regulated diet and lifestyle modifications such as a minimum of 8 hours sleep, 30-60 minute morning or evening walk and abstention from smoking/drinking”. The conclusion of the 90 day intervention found that there was a complete disappearance of headache pain and other migraine symptoms in 32.5% of the participants. All told, a total of 70.5% of the study volunteers observed a marked decrease in migraine frequency and pain severity. (12,13,14,15)

There are number of factors you need to consider when selecting any therapeutic approach. Do you prefer to pop a daily pill or have a procedure done periodically? Or, would you consider putting forth the effort to make more substantial lifestyle changes that may result in better overall health and thereby improve your symptoms? There are also financial considerations. Your insurance may fully or partially cover a pharmaceutical approach to address your “dis-ease”. But that’s unlikely to be the case if you opt for an alternative or complementary approach such as a dietary supplement or acupuncture. It’s also important to remember that just like conventional medical therapies, alternatives come with different price tags. By that, I don’t only mean how much money they’ll extract from your budget. I think it’s vitally important that you weigh all the benefits and costs of each respective option. Think in terms of effort, finances, potential side effects, sustainability and time considerations. I firmly believe that artfully planning your own path to wellness is always worth the forethought in the end.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Alternative Therapies, Mental Health, Nutritional Supplements

14 Comments & Updates to “Botox Migraines”

  1. Lynn Lotto Says:

    That is pretty scarey stuff – Botox for migraines, botox for anything. There are so many safe solutions for headaches and migraines. My biggest concern would be long term effects that are at this point still unknown.

  2. JP Says:


    That’s always something to keep an eye for: long term effects. Hopefully there won’t be any unexpected adverse reactions that only reveal themselves in time.

    Be well!


  3. stella Says:

    interesting, nice post

  4. JP Says:

    Update: In related news, EFT, a mind-body therapy, may be helpful …

    Explore (NY). 2013 Mar-Apr;9(2):91-9.

    Effect of the emotional freedom technique on perceived stress, quality of life, and cortisol salivary levels in tension-type headache sufferers: a randomized controlled trial.

    OBJECTIVE: To evaluate the short-term effects of the emotional freedom technique (EFT) on tension-type headache (TTH) sufferers.

    DESIGN: We used a parallel-group design, with participants randomly assigned to the emotional freedom intervention (n = 19) or a control arm (standard care n = 16).

    SETTING: The study was conducted at the outpatient Headache Clinic at the Korgialenio Benakio Hospital of Athens.

    PARTICIPANTS: Thirty-five patients meeting criteria for frequent TTH according to International Headache Society guidelines were enrolled.

    INTERVENTION: Participants were instructed to use the EFT method twice a day for two months.

    OUTCOME MEASURES: Study measures included the Perceived Stress Scale, the Multidimensional Health Locus of Control Scale, and the Short-Form questionnaire-36. Salivary cortisol levels and the frequency and intensity of headache episodes were also assessed.

    RESULTS: Within the treatment arm, perceived stress, scores for all Short-Form questionnaire-36 subscales, and the frequency and intensity of the headache episodes were all significantly reduced. No differences in cortisol levels were found in any group before and after the intervention.

    CONCLUSIONS: EFT was reported to benefit patients with TTH. This randomized controlled trial shows promising results for not only the frequency and severity of headaches but also other lifestyle parameters.

    Be well!


  5. JP Says:

    Update: Mindfulness meditation offers another mind-body approach to reducing headache pain …

    Nurs Midwifery Stud. 2014 Sep;3(3):e21136. Epub 2014 Sep 20.

    Effect of mindfulness-based stress reduction on pain severity and mindful awareness in patients with tension headache: a randomized controlled clinical trial.

    BACKGROUND: Programs to improve the pain and health status in illnesses with pain such as headache are still in their infancy. Mindfulness-based stress reduction (MBSR) is a new psychotherapy that appears to be effective in treating chronic pain.

    OBJECTIVES: This study evaluated efficacy of MBSR in improving pain severity and mindful awareness in patients with tension headache.

    PATIENTS AND METHODS: This study was a randomized controlled clinical trial that was conducted in 2012 in Shahid Beheshti Hospital of Kashan City. Sixty patients who were diagnosed with tension-type headache according to the International Headache Classification Subcommittee were randomly assigned to treatment as usual (TAU) or MBSR groups. The MBSR group received eight weekly treatments. Any session lasted 120 minutes. The sessions were based on MBSR protocol. Diary scale for measuring headache and Mindful Attention Awareness Scale (MAAS) were administered at pretreatment, and posttreatment, and three-month follow-up in both groups. The data was analyzed using repeated measures analysis of variance.

    RESULTS: The mean of pain severity was 7.36 ± 1.25 before intervention that was significantly reduced to 5.62 ± 1.74 and 6.07 ± 1.08 after the intervention and follow-up (P < 0.001). In addition, the MBSR group showed higher scores in mindful awareness in comparison with the control group at posttest session. The mean of mindful awareness before intervention was 34.9 ± 10.5 and changed to 53.8 ± 15.5 and 40.7 ± 10.9 after the intervention and follow-up sessions (P < 0.001). CONCLUSIONS: MBSR could reduce pain and improve mindfulness skills in patients with tension headache. It appears that MBSR is an effective psychotherapy for treatment of patients with tension headache. Be well! JP

  6. JP Says:

    Update 05/06/15:

    J Headache Pain. 2015 Dec;16(1):516.

    Improvement of migraine symptoms with a proprietary supplement containing riboflavin, magnesium and Q10: a randomized, placebo-controlled, double-blind, multicenter trial.

    BACKGROUND: Non-medical, non-pharmacological and pharmacological treatments are recommended for the prevention of migraine. The purpose of this randomized double-blind placebo controlled, multicenter trial was to evaluate the efficacy of a proprietary nutritional supplement containing a fixed combination of magnesium, riboflavin and Q10 as prophylactic treatment for migraine.

    METHODS: 130 adult migraineurs (age 18 – 65 years) with ≥ three migraine attacks per month were randomized into two treatment groups: dietary supplementation or placebo in a double-blind fashion. The treatment period was 3 months following a 4 week baseline period without prophylactic treatment. Patients were assessed before randomization and at the end of the 3-month-treatment-phase for days with migraine, migraine pain, burden of disease (HIT-6) and subjective evaluation of efficacy.

    RESULTS: Migraine days per month declined from 6.2 days during the baseline period to 4.4 days at the end of the treatment with the supplement and from 6.2.days to 5.2 days in the placebo group (p = 0.23 compared to placebo). The intensity of migraine pain was significantly reduced in the supplement group compared to placebo (p = 0.03). The sum score of the HIT-6 questionnaire was reduced by 4.8 points from 61.9 to 57.1 compared to 2 points in the placebo-group (p = 0.01). The evaluation of efficacy by the patient was better in the supplementation group compared to placebo (p = 0.01).

    CONCLUSIONS: Treatment with a proprietary supplement containing magnesium, riboflavin and Q10 (Migravent® in Germany, Dolovent® in USA) had an impact on migraine frequency which showed a trend towards statistical significance. Migraine symptoms and burden of disease, however, were statistically significantly reduced compared to placebo in patients with migraine attacks.

    Be well!


  7. JP Says:

    Update 06/11/15:

    Evid Based Complement Alternat Med. 2015;2015:920353.

    Acupuncture for Frequent Migraine: A Randomized, Patient/Assessor Blinded, Controlled Trial with One-Year Follow-Up.

    Objectives. This study aimed to evaluate the efficacy and safety of manual acupuncture as a prophylaxis for frequent migraine. Methods. Fifty frequent migraineurs were randomly allocated to receive 16 sessions of either real acupuncture (RA = 26) or sham acupuncture (SA = 24) during 20 weeks. The primary outcomes were days with migraine over four weeks, duration, and intensity of migraine and the number of responders with more than 50% reduction of migraine days. The secondary outcomes were the relief medication, quality of migraine, quality of life, and pressure pain thresholds. Results. The two groups were comparable at baseline. At the end of the treatment, when compared with the SA group, the RA group reported significant less migraine days (RA: 5.2 ± 5.0; SA: 10.1 ± 7.1; P = 0.008), less severe migraine (RA: 2.18 ± 1.05; SA: 2.93 ± 0.61; P = 0.004), more responders (RA: 19 versus SA: 7), and increased pressure pain thresholds. No other group difference was found. Group differences were maintained at the end of the three-month follow-up, but not at the one-year follow-up. No severe adverse event was reported. Blinding was successful. Discussion. Manual acupuncture was an effective and safe treatment for short-term relief of frequent migraine in adults. Larger trials are warranted.

    Be well!


  8. JP Says:

    Updated 08/25/15:

    Iran J Nurs Midwifery Res. 2015 May-Jun;20(3):334-9.

    The relationship between different fatty acids intake and frequency of migraine attacks.

    BACKGROUND: Migraine is a primary headache disorder that affects the neurovascular system. Recent studies have shown that consumption of some fatty acids such as omega-3 fatty acids improves migraine symptoms. The aim of the present study is to assess the association between usual intake of fatty acids such as eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and saturated fatty acids (SFA) with the frequency of migraine attacks.

    MATERIALS AND METHODS: 105 migraine patients with age ranging from 15 to 50 years participated in this cross-sectional study. Usual dietary consumption was assessed by using a semi-quantitative food frequency questionnaire (FFQ). Moreover, frequency of migraine attacks during 1 month period was determined in all participants. Data had been analyzed using independent sample t-test and linear regression test with adjustment of confounding variables.

    RESULTS: In this study, we found that lower intake of EPA (β = -335.07, P = 0.006) and DHA (β = -142.51, P = 0.001) was associated with higher frequency of migraine attacks. In addition, we observed similar relationship either in men or women. No significant association was found between dietary intake of SFA and the frequency of migraine attacks (β = -0.032, P = 0.85).

    CONCLUSIONS: Frequency of migraine attacks was negatively associated with dietary intake of omega-3 polyunsaturated fatty acids. No significant relationship was found between SFA intake and migraine frequency. Further studies are required to shed light on our findings.

    Be well!


  9. JP Says:

    Updated 10/17/15:

    Evid Based Complement Alternat Med. 2015;2015:930175.

    A Randomized Controlled Trial on the Effectiveness of Court-Type Traditional Thai Massage versus Amitriptyline in Patients with Chronic Tension-Type Headache.

    This study aimed to evaluate the effectiveness of the court-type traditional Thai massage (CTTM) to treat patients with chronic tension-type headaches (CTTHs) comparing with amitriptyline taking. A randomized controlled trial was conducted. Sixty patients diagnosed with CTTH were equally divided into a treatment and a control group. The treatment group received a 45-minute course of CTTM twice per week lasting 4 weeks while the control group was prescribed 25 mg of amitriptyline once a day before bedtime lasting 4 weeks. Outcome measures were evaluated in week 2, week 4 and followed up in week 6 consisting of visual analog scale (VAS), tissue hardness, pressure pain threshold (PPT), and heart rate variability (HRV). The results demonstrated a significant decrease in VAS pain intensity for the CTTM group at different assessment time points while a significant difference occurred in within-group and between-group comparison (P < 0.05) for each evaluated measure. Moreover, the tissue hardness of the CTTM group was significantly lower than the control group at week 4 (P < 0.05). The PPT and HRV of the CTTM group were significantly increased (P < 0.05). CTTM could be an alternative therapy for treatment of patients with CTTHs. Be well! JP

  10. JP Says:

    Updated 03/22/16:

    Funct Neurol. 2016 Mar 8:1-5.

    Melatonin 4 mg as prophylactic therapy for primary headaches: a pilot study.

    There is growing evidence that headaches are connected to melatonin secretion. Our aim was to assess the potential effectiveness of melatonin for primary headache prevention. Forty-nine patients (37 with migraine and 12 with chronic tension-type headache, TTH) were prescribed oral melatonin, 4 mg, 30 minutes before bedtime for six months. Forty-one (83.6%) of the 49 patients completed the study, while eight dropped out for personal reasons. A statistically significant reduction in headache frequency was found between baseline and final follow-up after six months of treatment (p=0.033 for TTH patients and p<0.001 for migraineurs). The Headache Impact Test score was significantly reduced in both groups of headache patients (p=0.002 and p<0.001, respectively). At baseline, melatonin levels, measured both during a headache attack and a pain-free period, did not differ between patients with TTH and migraineurs (p=0.539 and p=0.693, respectively), and no statistically significant differences in Hamilton Depression Rating Scale scores were found between the two groups. Melatonin 4 mg as prophylactic therapy for primary headaches: a pilot study This pilot study shows promising results, in terms of headache frequency reduction and daily quality of life improvement, in both groups.

    Be well!


  11. JP Says:

    Updated 05/09/16:

    Int Clin Psychopharmacol. 2016 May 2.

    Serum concentration of magnesium as an independent risk factor in migraine attacks: a matched case-control study and review of the literature.

    There is controversy over the role of magnesium in the etiology of migraine headaches. We aimed to evaluate and compare serum levels of magnesium between healthy individuals and those with migraine headaches during migraine attacks and between attacks to evaluate the role of magnesium in the etiology of migraine headaches. Forty patients with migraine headaches and 40 healthy individuals were enrolled in this matched case-control study. Malnutrition, digestive system disorders, history of smoking, drug abuse, and history of medications use were recorded at baseline. The pain scores of patients were measured and recorded based on a 10 cm visual analog scale. Subsequently, blood samples were collected at 8-10 in the morning to determine serum levels of magnesium. Analysis of variance, χ-test, and conditional logistic regression were used for data analysis. There were no significant differences in demographic data between the two groups. There were significant differences in magnesium serum levels between the three groups (1.09±0.2 mg/dl during migraine headaches; 1.95±0.3 mg/dl between the attacks; and 1.3±0.4 mh/dl in the control group; P<0.0001). Odds of acute migraine headaches increased 35.3 times (odds ratio=35.3; 95% confidence interval: 12.4-95.2; P=0.001) when serum levels of magnesium reached below the normal level. The odds in patients who are not in the acute attack phase were 6.9 folds higher (odds ratio=6.9; 95% confidence interval: 1.3-2.1; P=0.02). The serum level of magnesium is an independent factor for migraine headaches and patients with migraine have lower serum levels of magnesium during the migraine attacks and between the attacks compared with healthy individuals.

    Be well!


  12. JP Says:

    Updated 06/06/16:

    Schmerz. 2016 Jun;30(3):295-310.

    [Peppermint oil in the acute treatment of tension-type headache].

    Tension-type headache is the most frequent form of headache. The local topical treatment with peppermint oil (oleum menthae piperitae) has proven to be significantly more effective than placebo in controlled studies. Peppermint oil targets headache pathophysiology in multiple ways. The efficacy is comparable to that of acetylsalicylic acid or paracetamol. Solutions of 10 % peppermint oil in ethanol are licensed for the treatment of tension-type headache in adults and children above 6 years. It is included in treatment recommendations and guidelines by the respective professional societies and is regarded as a standard treatment for the acute therapy of tension-type headaches.

    Be well!


  13. JP Says:

    Updated 06/26/16:

    Neurol Sci. 2016 Jun 23.

    The efficacy of lymphatic drainage and traditional massage in the prophylaxis of migraine: a randomized, controlled parallel group study.

    This study aimed at examining the efficacy of lymphatic drainage (LD) and traditional massage (TM) in the prophylactic treatment of migraine using controlled prospective randomized clinical trial of 64 patients (57 women, 45 ± 10 years) with migraine with and without aura. Patients were randomized into three groups: LD (n = 21); TM (n = 21); waiting group (WG, n = 22). After a 4-week-baseline, a treatment period of 8 weeks was applied followed by a 4-week observation period. The patients filled in a headache diary continuously; every 4 weeks they filled in the German version of the CES-D and the German version of the Headache Disability Inventory. The main outcome measure was migraine frequency per month. At the end of the observation period, the number of migraine attacks and days decreased in the LD group by 1.8 and 3.1, respectively, in the TM group by 1.3 and 2.4, and in the WG by 0.4 and 0.2, respectively. The differences between LD and WG were significant (p = 0.006 and p = 0.015, respectively) as well as the differences between TM und WG (p = 0.042 and p = 0.016, respectively). There was a significant decrease in the amount of analgesic intake in the LD group compared to the two other groups (p = 0.004). TM and LD resulted in a reduction of migraine attack frequency. The analgesic intake only decreased significantly during LD intervention. Useful effects were identified for LD and TM as compared to WG for the prophylaxis of migraine. LD was more efficacious in some parameters than TM.

    Be well!


  14. JP Says:

    Updated 10/02/16:

    Acta Neurol Belg. 2016 Sep 26.

    Effectiveness of coenzyme Q10 in prophylactic treatment of migraine headache: an open-label, add-on, controlled trial.

    Despite the huge health and economic burden of migraine headache, few medications have been approved for its prophylactic treatment, most of which can potentially induce serious adverse effects. Coenzyme Q10 (CoQ10) is a supplement and has shown preliminary benefits in migraine prophylaxis. We aimed to assess this effect in an adult population. This is an open-label, parallel, add-on, match-controlled trial. Eighty patients diagnosed with migraine headache based on International Headache Society criteria were allocated to receiving only their current preventive drugs or their current preventive drugs plus 100 mg CoQ10 daily, matching for their baseline characteristics, and were assessed for frequency and severity of attacks, and ≥50 % reduction in attack frequency per month. Thirty-six and 37 patients were analyzed in CoQ10 and control groups, respectively. Number of attacks per month dropped significantly in the CoQ10 group (mean decrease: 1.6 vs. 0.5 among CoQ10 and control groups, respectively, p < 0.001). A significant reduction was also evident in the severity of headaches (mean decrease: 2.3 vs. 0.6 among CoQ10 and control groups, respectively, p < 0.001). For ≥50 % reduction in the frequency of attacks per month, the number needed to treat was calculated as 1.6. No side effects for CoQ10 were observed. This study suggests that CoQ10 might reduce the frequency of headaches, and may also make them shorter in duration, and less severe, with a favorable safety profile. Be well! JP

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