We most commonly know Botox® (botulinum toxin) as being used for cosmetic purposes, but it is about to be made available to patients suffering from migraines through the UK’s National Health Service (NHS). Botulinum toxin is a protein and neurotoxin produced by the bacterium Clostridium botulinum. But is injecting a potentially deadly bacterial toxin really the way forward for treatment of migraine?

NICE and effective?

After receiving extra data from manufacturer Allergan, the National Institute for Health and Clinical Excellence (NICE) has published new draft guidance endorsing the use of Botox® to prevent chronic headaches. This is worrying, considering that Allergan was battling 3 lawsuits in 2011 alleging that Botox® could cause brain damage, and that the Botox® website itself claims: “It is not known whether BOTOX® and BOTOX® Cosmetic is safe or effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine)”. Allergan has also been accused of hiding Botox-related deaths from the US Food and Drug Administration (FDA), so where they've plucked these glowing analyses from is anyone’s guess.

Over-reaching the target

The science behind using Botox® medically is that it denervates (or weakens) muscles, but this effect is only short-lived, lasting just 3 to 6 months. Therefore, to consistently stop headaches using this method, the patient may have to have Botox® injections every 3 months. This gives yet more cause for concern, as Botox® can bring about adverse effects in not only the target muscle but also non-target muscles. This decreases muscle strength and mass in both the injected muscle and muscles far removed from the injection site. And then once a muscle has been continually weakened, it can turn to fat!

Address the cause or silence the symptom?

Any discomfort, pain or ill-health is the body’s way of saying that something is out of balance. Conventional medicine happily hands out pills to mask these symptoms, and now they are offering injections of a “fatty toxin” that can cause botulism — a serious and life-threatening illness, to mask the symptoms of migraine. That these symptoms are enormously painful and debilitating is a powerful sign that something is out of balance, and requires attention. We strenuously question whether such an approach from a health care provider is either appropriate or responsible. When the body is screaming that something is wrong, using a toxin to render it mute without looking into other potential physiological considerations seems like sheer madness.  The causes of headaches and migraines are well known to be numerous and often multifactorial. Many have gained significant benefit from such interventions as osteopathy, chiropractic, massage, nutritional changes and interventions, relaxation and breathing techniques and targeted lifestyle changes. Surely they're worth a try before turning to a toxin that may or may not damage your brain? To put it in very simple terms – if you had a gas leak, would you call the gas fitter to fix it, or would you just stick some tape over the hole and hope that no one lights a match?

The pipeline's running dry

It is common knowledge that the pharmaceutical pipeline is nearing empty and that the main patents on the blockbuster drugs are in the process of expiring. The new trick in town, at least in Pharma City, seems to be 'let's plunder existing products and try to find new indications and new uses on entirely new sectors of the population that have so far been untapped'. Fancy some botox anyone?

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