Is there really a cure for a bad headache? It depends on the type and frequency of the headaches.

Anti-wrinkle injections and its effectiveness on headaches is in the news again.

The Journal of the American Medical Association recently published the results of a review on the effectiveness of the key ingredient in anti-wrinkle injections, in preventing headaches in adults. For the purposes of the review, headaches were categorised as episodic or chronic migraine headaches and episodic, chronic daily or tension headaches. Headaches were considered episodic if they occurred less than 15 times a month; and chronic if they occurred 15 or more times a month.

The review covered 31 randomised controlled studies, 27 that compared anti-wrinkle injection treatments with a placebo, and four studies that compared anti-wrinkle injection treatment with other headache treatments.

Results of the analysis showed that the anti-wrinkle injections reduced the number of chronic migraine events per month to 17.2 from 19.5; it also reduced chronic daily (tension) headaches, from 17.5 days to 15.4 days. Along with a decrease in headaches, however, some participants reported such side effects as weak muscles and a stiff neck.

The reviewers concluded that: “Anti-wrinkle injections compared with placebo was associated with a small to modest benefit for chronic daily headaches and chronic migraines but was not associated with fewer episodic migraine or chronic tension-type headaches per month.

Reuters Health quotes the lead researcher, Dr. Jeffrey Jackson from the Medical College of Wisconsin in Milwaukee, as saying: “The effect these appear to be having on migraine headaches is small— it only reduces headaches by a couple of days a month,” and that the impact is “really, really modest.

While the benefits may sound modest to someone who does not suffer from migraines or chronic headaches, those who do suffer would appreciate the extra pain-free hours.

Crystal Muilenburg, spokeswoman for Allergan, the manufacturer of one anti-wrinkle injection product, expressed a similar view, adding that two additional migraine-free days a month equates to 24 days a year. She also explained that these statistics do not reveal the whole story. According to company-funded studies, anti-wrinkle injections also shortens migraine time in hours, and it decreases the severity of the headaches.

It is not news to doctors or to Allergan that anti-wrinkle injections helps chronic migraine sufferers. In fact, Allergan’s anti-wrinkle injections gained the approval of the US Food and Drug Administration in 2010 as a treatment to prevent chronic migraines. It gained similar approval from Britain’s Medicines and Healthcare Products Regulatory Agency (MHRA) in the same year.

Dr. Jackson notes: “For people with headaches less than 14 days a month or anyone with a tension headache, it clearly doesn’t work.” According to the American Headache Society, tension headaches are the most common type of headache, with about 42 percent of adults experiencing them sometime in their lives. As it is, anti-wrinkle injections are prescribed for about 3 percent of adults who suffer from tension headaches 15 or more days a month, beyond which point they are considered chronic. Based upon global statistics, migraines are less common, affecting between 8 and 18 percent of the population, but they cause greater disability. In the US alone, migraines account for about $16 billion in lost productivity each year; and for $1 billion in annual medical costs.

The idea that anti-wrinkle injections might minimise tension headaches developed from the theory that the muscle-paralysing drug would help relax contracting muscles causing the pain. Experts accepted this theory because tension headaches are usually triggered by factors such as hunger, fatigue, stress, poor posture and overexertion. In view of his latest findings, this theory of the causes of tension headaches may need revision, says Dr. Jackson. “Anti-wrinkle injections lack of effect on tension headaches suggests that the old theory of muscles contracting is probably not true”.

In Bloomberg Business Week, Robert Duarte, Director of the Pain Center at the Cushing Neuroscience Institute in Manhasset, New York, offered an expanded explanation as to why anti-wrinkle injections don’t appear to offer significant benefit. He says that some studies included in the review used differing doses of anti-wrinkle injections, many of them lower than the current US-approved dose, and that this may explain why the results show only a slight benefit.

According to Duarte, “It still demonstrates that for chronic migraines this is the treatment of choice.” He went on to say, “We have seen clinically that patients’ headaches have been significantly reduced. It is not a cure. It is maintenance therapy. This is the best treatment that we have to date.

According to the Allergan 2011 Annual Report, about half of their anti-wrinkle injections US$1.59 billion worldwide sales for that year were for therapeutic uses, including treatments for chronic migraines, severe underarm sweating and urinary incontinence. A breakdown of these figures does not indicate what percentage of the sales was for migraines.

The bottom line: If you suffer from chronic migraines or chronic headaches, anti-wrinkle injections will bring you moderate relief. It may help reduce the number of your headaches as well as their severity. If you suffer from episodic headaches or migraine (fewer than 15 times a month), anti-wrinkle injections, compared to other headache treatments may offer help.

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