Botox Can Ease Painful Spinal Headaches

Botox may offer new hope to patients suffering from disabling low cerebrospinal fluid headaches (CSF), according to findings from a Mayo Clinic study that shed new light on OnabotulinumtoxinA injection, as well as headache treatments in general. The case study was presented at the 63rd Annual Meeting of the American Academy of Neurology meeting held in March.

Low CSF pressure headaches are caused by an internal spinal fluid leak and are most commonly triggered by a lumbar puncture. The pain, which can range from slight to disabling, is caused as fluid leaks out and the brain sags.

For many patients, lying down has offered the only relief, because existing therapies weren't fully effective. Traditional treatment involves injecting a patch of the patient’s blood over the puncture hole.

The patient in the case study suffered low CSF pressure headaches for 25 years. For most of that time, she only felt better while lying down, which severely curtailed her day-to-day activities. Five years ago, she sought help from Michael Cutrer, MD, and Paul Mathew, MD.

The patient has received Botox for three years and the results have been consistently positive. After each treatment, improvement would last for three months before pain returned, requiring another dose. Although the patient is not cured, she is now able to live a more normal life.

"We had been using Botox for several years for treatment of migraine and had been successful in many patients. And because we really didn't have anything else to offer her, we gave her the Botox," said Dr. Cutrer, a neurologist at Mayo Clinic in Rochester, Minnesota, and the report’s co-author, in a press release. "To everybody's surprise, she made a remarkable improvement." The intensity of the patient's headaches dropped from 8 out of 10 on a visual pain scale to 3 out of 10.

For more:

• Video: Mayo Clinic Finds Botox Eases Painful Spinal Headaches (Mayo Clinic)
• FDA approves Botox to treat chronic migraine (FDA)
• Experience with onabotulinumtoxinA (BOTOX) in chronic refractory migraine: focus on severe attacks (The Journal of Headache and Pain)