Botox: The new drug for migraines


Special to The Miami Herald

Elizabeth Hogan first started getting migraines in high school.

By her 30s, Hogan, a Miami Realtor, was getting the debilitating headaches up to five days a week. She spent most of her time in a dark, silent bedroom with an ice pack on her head. Hogan found herself canceling outings with friends, putting off seeing her boyfriend and answering work emails during the few hours she was able to get out of bed. Luckily, as a luxury residential real estate agent, Hogan was able to make her own schedule and could still support herself, and friends and her boyfriend were understanding.

Hogan tried various remedies, including a medication called Zomig, but that proved a temporary solution — the headache would return even worse when the medicine wore off.

“I felt hopeless,’’ Hogan said.

Then she found Dr. Allan Herskowitz, chief of neurology at Baptist Hospital, who started treating Hogan with carefully targeted Botox shots in her neck and head. Now, Hogan’s migraines have diminished to twice a month.

“This has really been life-changing,’’ said Hogan, 44. “I will probably have migraines for the rest of my life, they run in my family. But I am dramatically better. Dr. Herskowitz gave me my life back.’’

Hogan is one of thousands of migraine sufferers who have benefitted from what they are calling the migraine wonder drug of the decade: Botox. The drug, which was just approved by the FDA in 2010, is only used for major migraine sufferers, those who are not helped by medications and lifestyle changes and suffer from the headaches at least 10 to 15 days a month. But for those victims, the drug has proven to be life-changing, causing patients to shower their doctors with prayers, thanks and tears of gratitude.

“I’m set for life,’’ said Dr. Teshamae Monteith, a headache specialist at the University of Miami. “My patients say, ‘I pray for you, God bless you.’ It’s almost shocking to me how grateful they are. It’s like they came back from the dead.’’

Migraines, which come from the Greek word Hemikrania, or “pain on one side of the head,’’ have plagued many historical figures, including Thomas Jefferson, painters Vincent Van Gogh and Claude Monet, authors Virginia Woolf and Lewis Carroll, Julius Caesar, Napoleon, Ulysses S. Grant, Robert E. Lee, Mary Todd Lincoln, Sigmund Freud, philosopher Friedrich Nietzsche, and entertainers Elvis Presley and Elizabeth Taylor. Experts estimate that 15 percent of the population is affected by migraines at some time.

Migraines differ from tension and garden-variety headaches in that the pounding pain is typically accompanied by nausea, vomiting and an “aura,” or sensory disturbance that can signal the onset. The headaches are exacerbated by light and noise, which is why most sufferers recover in a dark, silent room. About two-thirds of cases run in families, and two to three times as many women suffer from them than men. While the exact cause of migraines are unknown, hormones and heredity are thought to be critical factors. Thankfully, doctors say they appear to disappear as people age.

Once doctors diagnose a person with migraines, they start by treating them prophylatically, with medications like triptans or ergot. Some doctors ask patients to keep a lifestyle diary, noting what they eat and drink, their sleep habits and stress levels.

“You look at the causative factors and try to slowly eliminate them,’’ said Herskowitz, who also serves as team doctor for the Miami Heat.

Among the dietary triggers for some are red wine, preservatives like MSG (often used in Chinese food), aged cheese and chocolate, Herskowitz said. A disturbance in sleep patterns, or not getting enough sleep, is another potential trigger, as is high stress. And warm weather and the accompanying high barometric pressure seems to be a factor: Cleveland Clinic Florida reports a 7.5 percent increase in emergency room visits because of migraines.

“There’s a correlation,’’ said Dr. Adriana Rodriguez, a Cleveland Clinic neurologist. “There’s even a lightning trigger for migraines. We advise people to stay well-hydrated in the summer and avoid exercising in the peak hours of the day.”

Candace West, a Fort Lauderdale freelance photographer, developed migraines at the age of 30. She would spend several days a month on her bathroom floor with a pillow and would have to call in sick from her photography job.

Dr. Steve Wheeler, a neurologist at Baptist Hospital, helped West develop a treatment plan that took many months to perfect.

“He suffers from them himself so he had great empathy,’’ West said. “It’s truly a journey. There’s no magic pill. What triggers one person doesn’t trigger others.’’

After keeping a headache diary, West began to discover, and avoid, her triggers — cheese, red wine and chocolate. She also started taking a daily medication, Topamax, intended to prevent seizures, gave up processed foods and alcohol, and started yoga and weight training.

Now, West has her migraines under control. When she gets one, usually around her menstrual cycle, she treats it immediately with Imitrex, an injection, and is usually up and around within an hour. She sees her neurologist once every five years for a “tune-up.”

“Now I can function. I say, give me an hour, I need to treat,’’ she said. “I don’t have to opt out of my life.’’

But medication and headache diaries don’t work for all patients. Cleveland Clinic Florida offers patients special infusions containing a cocktail of drugs, includ* ing magnesium, the anti-seizure medication Depakote and others. Patients have the option of checking into the hospital for 24 hours and getting the series of three infusions every eight hours, or visiting the outpatient infusion center.

Cleveland Clinic Florida also offers Botox injections to those who meet the criteria of getting 10 migraines a month lasting for four hours at a time. About 30 percent of migraine patients opt for Botox, Rodriguez said.

“Botox is the latest and most effective cutting-edge treatment,’’ said Rodriguez, who noted that patients were able to get the treatment before FDA approval but had to pay for it out of their own pockets because insurance would not cover it.

Herskowitz has treated 1,500 migraine patients with Botox. Initially, patients get injected every three months, and later, every six months, he said. An astounding 85 percent improve with the treatment, he said.

But doctors have to get special training to know how and, more importantly, where to inject the Botox to extinguish the migraines. Only a handful of neurologists in South Florida offer the service, and patients report a waiting list to see these doctors.

The University of Miami also treats patients with infusion therapy. “We’ve had a lot of success with that,’’ said Monteith. “It breaks the headache cycle.’’

“Some people have had headaches for decades and this is the first relief they’ve seen,’’ she said. “It’s so great to see them get their life back.’’

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