Barbara Bragg, 37, is convinced that Botox will finally straighten out her headache problems.
"Anybody who's got migraines needs to get this done," she said, wincing as she received 35 injections of the sterilized bacteria at Medical College of Georgia Hospital and Clinics.
At the American Headache Society's recent annual conference, findings were presented from the first large-scale study using Botox to treat migraine headaches, which is not an FDA-approved treatment. But Ms. Bragg, of Sardis, Ga., has been relying on the treatment for years.
"I tried two or three medications, but nothing helped," said Ms, Bragg, who was thrown from a horse in 2001 and landed on her head. After she emerged from a monthlong coma, the headaches began.
She started receiving Botox injections in her forehead, temples and neck in 2003.
"I had headaches before, but nothing like this," she said.
Although most people are familiar with the use of botulinum toxin A (Botox) for smoothing out wrinkles, the headache treatment is more controversial, said Ms. Bragg's neurologist, Michael Rivner.
He said the injections are only a last resort for patients who suffer from multiple weekly headaches and for whom other medications have no effect.
Even though Ms. Bragg said the "worry line" wrinkle between her eyebrows has disappeared, the painful and expensive injections would not be worth it otherwise.
"If I didn't have headaches, I'd take the wrinkles back every day," she said.
Ms. Bragg said it takes her two days to recover from the extensive shot therapy and that she enjoys 2 months of headache relief. Because patients could develop immunity to the drug, Dr. Rivner only performs injections every three months.
It has been eight months since Ms. Bragg's last treatment, though, because her insurance provider - Medicaid - stopped paying for the shots.
"This is a big problem with these headache injections," said Dr. Rivner, who has been injecting Botox for various reasons since 1989.
"They claim that it's experimental. They worry that patients are using it for cosmetic reasons," he said.
A vial of Botox, which is related to the food poison botulism, costs between $600 and $1,000, Dr. Rivner said. Two vials are used for headache patients, but far less is injected for wrinkles.
"I think they're getting better," Ms. Bragg, who has since resumed horseback riding, said of her headaches. But she looks forward to ending Botox treatments someday.
Dr. Rivner, who has treated about 20 patients with similar problems, says that probably won't happen.
"Unfortunately, that's usually not the case," he said. "The toxin is not a cure. It just helps with the symptoms."
Reach Rebecca Trela at (706) 828-3904 or rebecca.trela@augustachronicle.com.
Botox for Migraines
Using Botox to treat migraines is an off-label use, not approved by the FDA. Further clinical trials must be scheduled before the agency will consider the treatment. Those trials are scheduled for late 2006 or early 2007. Doctors aren't entirely sure how the bacteria works to help headaches - only that it does.
"It happened that some patients being treated for wrinkles told their doctors that they experienced headache relief," Dr. Michael Rivner said. "We think that it interferes with pain functions."
Another theory suggests that Botox releases muscle tension, an irritant to the nervous system.
"It doesn't help everybody - only about 70 percent of the patients," Dr. Rivner said. He said he is the only neurologist treating migraines with Botox at MCG but that three or four other doctors in the Augusta area are offering the treatment. Side effects of Botox injections can include eyelid droop, double vision, weakness and neck pain. For more information, visit the American Council for Headache Education Web site: www.achenet.org.
Sources: Dr. Jack Klapper, Colorado Neurology & Headache Center; Dr. David Dodick, the Mayo Clinic in Scottsdale, Ariz.; and Dr. Michael Rivner, Medical College of Georgia
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