Illustration by Firecatcher
By Kathy Bergstrom
Bethany Coats-Topel, 43, had suffered run-of-the-mill headaches before, but in fall 2009, she began to experience daily migraines so severe that they affected her quality of life. “It never went away,” she says. “I couldn’t sleep because of the pain.”
She was tired all the time and unable to focus on her job as a hospice social worker in Pleasant Prairie. When she wasn’t at work, she wanted to hole up in a dark, quiet room by herself. A trip to an ear, nose and throat specialist proved sinuses weren’t the problem. Ibuprofen merely took the edge off the pain. And visits to a chiropractor and acupuncturist only offered short-term relief.
After nearly two years of pain and few answers, Coats-Topel sought help at the Wheaton Franciscan Comprehensive Headache Center in Franklin. The recommendation? Botox.
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– Julie Sensat Waldren
Although most know the botulinum toxin for its cosmetic use to reduce the appearance of wrinkles, it’s also used to treat uncontrolled blinking, crossed eyes, muscle spasms and excessive underarm sweating. In October 2010, the U.S. Food and Drug Administration added chronic migraines to the drug’s growing list of approved uses.
This was welcome news for the estimated 50 million Americans who suffer from migraine headaches, says Dr. Traci Purath, a neurologist and the headache center’s medical director. According to the U.S. Department of Health and Human Services, up to three-quarters of migraine sufferers are women. Purath has treated her patients with Botox for more than 10 years – 75 percent of her patients have chronic migraines, and 25 percent receive Botox.
But Purath increased her usage of the treatment after FDA approval. Using a drug for an unapproved indication, so-called “off-label” use, is common, but insurance companies rarely cover it. For a treatment that can cost up to $2,000 per visit, FDA approval makes it much more accessible.
Botox is recommended for chronic migraine sufferers – those who have at least 15 headache days each month. Unlike the six or
so injections patients receive for cosmetic issues, each migraine treatment involves 31 Botox injections around the face, head and neck. Doctors believe the injections relieve pain by decreasing tightness in the head and neck, and decreasing pressure on nerve endings called nociceptors at the injection sites. However, Purath says the injections will not stop patients from having migraines completely and should be used as a complementary treatment. “It does not solve what a migraine is,” she says. “It truly is an adjunct therapy.”
Besides the initial pain during injections, Botox has few side effects because of the low dose and its focused application, says Dr. Eric Dvorak, the medical director at Aurora Medical Center in Summit. “It can offer help for people who have tried everything else,” he says. The biggest side effect is muscle relaxing – such as limited eyebrow movement – that can be uncomfortable for some patients, Purath says. Coats-Topel notices she must lift her eyebrow with her fingers when applying eye makeup.
Staying up to date on the treatment is essential, Purath says, because the drug eventually leaves the system. She recommends three-month intervals between treatments but says some patients have been able to stretch it out.
Coats-Topel started getting injections in May 2011 and receives treatments every three months. The results have been life-changing. “All of a sudden,” she says, “I was sleeping through the night and didn’t have any pain. I don’t come home from work and have to lie down every day. I participate in life again.”