How Botox can help with Cluster Headaches

This article discusses research that is currently being done to turn Botox into a treatment for cluster headaches.

Botox is best known as a facial wrinkle remover, but if all goes well with the research, someday soon it may be a treatment option for cluster headache. At least that is the hope of a team of scientists at the Norwegian University of Science and Technology (NTNU).

Why Botox?
Botox (onabotulinumtoxinA) is a neurotoxin and a drug that uses a potent poison called botulinum toxin, which is derived from the bacterium Clostridium botulinum. When it is injected into facial muscles, it paralyzes them temporarily and causes wrinkles to disappear for several months.

Similarly, injections of the toxin are used to block nerve signals that cause muscles contractions in cerebral palsy and bladder spasms, to block postsurgical pain and foot pain, and to temporarily relax eye muscles in people with strabismus (misaligned eyes). Botox also is sometimes used to treat migraine.

Cluster headache and Botox
Cluster headache pain is more severe than migraine pain and can drive patients to perform desperate acts, even suicide, to avoid it. Therefore finding effective treatments for this devastating condition, which affects an estimated 53 people per 100,000 per year, is essential.

That’s why Erling Tronvik, NTNU senior consultant and researcher, along with two colleagues, are about to undertake a study of the impact of Botox on cluster headache sufferers. This team has devised a treatment device that will allow them to shoot Botox through a hole in the nasal wall into a nerve bundle located behind the sinuses.

Clinicians will use magnetic resonance imaging (MRI) scans to accurately identify the location of the nerve bundle in each patient before treatment is initiated. According to Tronvik, this unique approach should (in theory) reduce or eliminate the flow of signals in this area for three to eight months, after which time patients would need to get another treatment.

“We designed the equipment ourselves, and Botox has never been used for this anywhere else,” noted Tronvik. Soon, 10 patients will enter the first pilot study of this treatment method.

If the results of the pilot study are positive, the team plans to enroll 30 to 40 patients who suffer with cluster headache and about 80 migraineurs as well.

Are there any side effects? Tronvik explained that use of MRI is a highly accurate way to locate the exact spot to inject the Botox. However, he also noted that if the toxin were to slightly miss the mark, patients could experience a weakened ability to chew or temporary double vision.

In the meantime, there’s some good news regarding chronic migraine. Botox has been shown to be helpful in relieving chronic migraine, as seen in the results of the PREEMPT (Research Evaluating Migraine Prophylaxis Therapy) clinical program.

In that study, nearly 70 percent of patients treated with Botox experienced at least a 50 percent reduction in the frequency of headache days. Other research has shown Botox to be effective as preventive treatment for chronic migraine and to provide a reduction in severity and intensity of pain as well as the number of days with disability.

If you suffer with cluster headache, a new effective treatment can’t come soon enough. Hopefully Botox or another option in the pipeline will prove beneficial in the near future.

Study References
Alvaro-Gonzalez LC et al. Botulinum toxin A in chronic refractory migraine: premarketing experience. Revista de Neurologia 2012 Oct 1; 55(7): 385-91
Aurora SK et al. OnabotulinumtoxinA for chronic migraine: efficacy, safety, and tolerability in patients who received all five treatment cycles in the PREEMPT clinical program. Acta Neurologica Scandinavica 2014 Jan; 129(1): 61-70

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Botox to treat extreme cluster headaches

Botox could be used to help treat extremely painful cluster headaches and migraine headaches.

"I hit myself in the head to distract myself from the pain when I have a cluster headache. The pain is indescribable hell, and in desperate moments, I have hit my head against a brick wall and hit myself in the head with a cell phone," says Hilde Vollan (34), a PhD candidate in bioinformatics at the University of Oslo.

Four years and four months ago, her life turned upside down when she started getting cluster headaches. Her life has been transformed -- once, she was an active student with many friends, but she now lives a life in the dark at home with her parents. She has two to five cluster headaches every day, and also suffers from migraine and tension headaches. If she dares to go out for a walk, she always brings someone who can support her, and a bag of pills -- including an oxygen bottle, a mask to breathe with and migraine medicines she takes by injection. Her attacks can come in the middle of the street or inside a store.

"For years, I have tried to hide when the pain takes over, because people are scared and shocked to see me suffer such pain. But I've stopped hiding now. It's not my fault that I get such bad headaches," says Vollan.

Now, Vollan will participate in a pilot study at the Norwegian University of Science and Technology (NTNU) where she will help in the testing of a new treatment.

Men more susceptible than women

"We also call this a suicide headache, because many sufferers become suicidal," says NTNU senior consultant and researcher Erling Tronvik.

"This is the most extreme form of a headache, and the intensity of the pain is worse than what migraine patients experience. I've had patients tell me that they bang their head against the wall because of the pain. Others say that they put their thumb in a pair of pincers while they pull with all their might, all in a desperate attempt to deflect the intense pain," says Tronvik, who is also affiliated with the Norwegian National Headache Centre at St. Olavs Hospital in Trondheim.

Unlike migraines, which mostly afflict women, cluster headaches mainly occur in men. About 5000 Norwegians suffer from cluster headaches. Some have daily seizures for a few months each year, while others have attacks several times a day, every day of the year.

Crippled by Pain

"People who get these headaches daily are crippled by the pain. It's an extremely challenging disease for both doctors and patients," Tronvik says.

Until now, it has been difficult to help these patients. Scientists do not know why some people get cluster headaches. A number of patients have found relief from injections of migraine medicine and the use of oxygen, but this treatment does not help most sufferers. The illness leaves patients with a tremendous sense of helplessness.

But now Tronvik, in collaboration with physician Daniel Bratbak at St. Olavs Hospital and Professor Ståle Nordgård at NTNU, has come up with an entirely new treatment. The gear they have developed looks a pistol with a very thin barrel, just the thickness of a knitting needle. The barrel is inserted up through the nose of the patient, and by passing through a natural hole in the nasal wall, the mouth of the barrel comes to a bundle of nerves behind the sinuses.

The surgeon pulls the trigger of the pistol, which shoots a dose of Botox to the area around the nerve bundle. The whole process takes about a half-an-hour.

In search of patients

"Botox is a neurotoxin that stops the flow of impulses along the nerves. In theory, the connection between the two nerves in the bundle is reduced or eliminated. The effect lasts from three to eight months. Then the patient has to get another injection. We designed the equipment ourselves, and Botox has never been used for this anywhere else," says Tronvik.

The researchers strongly believe in their treatment method, in part because a new study unrelated to their work has shown an effect by using an electric current to paralyse the nerve bundle.

"But that approach requires a lengthy operation," Tronvik says. Now he's in search of ten patients for a pilot study.

If the method proves to be effective, the researchers will extend the experiment to include 30 to 40 cluster headache patients and approximately 80 migraine patients. The treatment uses an MRI of the patient's head to make certain that the surgeon knows exactly where the nerve bundle is. A navigation tool, composed of three small spheres on the pistol, and a plate with three spheres mounted on the patient's head, enables the surgeon to find the nerve bundle using the MRI image.

Tested on two patients

"A computer sends light signals to all the spheres to form precise points. We don't miss, but anyone who wants to participate in the study must accept the risk that it could happen, because this has never been done before. If the Botox hits an area near the nerve bundle, it could cause temporary double vision, or weaken the ability of the patient to chew. But with the use of the MRI and our navigation tools we can hit the nerve bundle without any problem. We hope that this treatment method can help give patients a life without such great pain," says Tronvik.

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Blast of ice up the nose eases migraines

um....in the category of strange news....There is no data yet on this invention. Its under study. Please do NOT squirt ice, ice cream, Italian ice or other liquids up your nose for migraine.

But, who knows, this is how discoveries are made. Im looking forward to results. JR

P.s. What did one snowman say to the other snowman?   Do you smell carrots?




A device claims to ease migraine headaches and cluster headaches by blasting cold liquid into the nose to cool the brain.

A device that cools the brain by blasting ice cold liquid into the nostrils could be a radical new treatment for migraine.

The gadget, which manufacturers say may also help treat a severe type of headache called cluster headache, comes in the wake of anecdotal reports from some patients that eating ice cream reduces or even cures their headache.

Research shows that migraines and cluster headaches can be triggered when blood vessels in the brain expand. The idea behind the device, which sprays liquid into the nostrils for 20 minutes and is operated by doctors in a clinic, is that it cools these vessels, making them shrink to a normal size.

The liquid flows into an area at the top of the patient's nostrils called the nasal cavity. Directly behind this area are numerous blood vessels that supply the brain. 

The cold liquid cools these blood vessels - this not only makes them contract, but also means they deliver cooler blood to the rest of the brain. This leads to the overall temperature of the brain dropping, and causes blood vessels throughout the brain to constrict back to a normal size.

Migraine affects around 15 per cent of UK adults, and is a severe headache that can be accompanied by visual disturbances or nausea. Cluster headaches, which are excruciating attacks of pain in one side of the head, affect around one person in a thousand.

The battery-powered device, roughly the size of a large handbag, was originally designed to prevent brain damage following heart attack or stroke. Both of these conditions cause brain cells to be deprived of oxygen, which triggers the release of various damaging molecules. 

However, reducing the temperature of the brain is thought to prevent the release of these harmful compounds, although scientists are still unsure how exactly it does this. 

When used to treat heart attack or stroke victims, the device causes a drop of 2.5c in the brain, although it will not trigger such a large drop when used for migraine and cluster headaches.

In a new trial, UK scientists from Penrith Hospital, Cumbria, will use the device on 15 patients who will receive ten treatments each, whenever a migraine strikes, for a maximum of 20 minutes at a time.

The liquid is inserted into the nose through a thin tube - once it hits the warm nasal cavity it evaporates, which helps to further cool the surrounding tissue.

The team decided to investigate the use of this device after noting that ice packs and cold foods seem to ease the painful headaches. 

The patients will be monitored during the treatment and for two hours afterwards to assess headache severity and side-effects. There will be a further follow-up two months after the last treatment. 

Commenting on the device, Dr Andrew Dowson, head of headache services at Kings College Hospital, London and chairman of Migraine Action's medical advisory board, said: 'Patients with migraine often use cold, heat or pressure to the head and neck to manage at least some of their symptoms. This pilot study in is interesting, and if positive will trigger larger trials.'

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How to tell if your headache is a migraine

This article discusses how to tell if your headache is truly a migraine or not. Also, it discusses good ways to try and alleviate migraines.

Have you ever wondered why your headache just won’t go away? It could be because you’re not treating it correctly. There are several types of headaches, which we often confuse with one another. Each is marked by different symptoms and characteristics. In order to properly treat a headache, you must be able to identify which type of headache you’re experiencing.

Tension Headache: Tension headaches are the most common type of headache, and as many as 30 to 78 percent of the general population experience them during their lifetime. This type of headache appears periodically and can last from 30 minutes to several days. The pain is a mild to moderate pressure or tightness, which typically doesn’t interfere with daily activities. Over-the-counter pain medications can be used to treat tension headaches.

Sinus Headache: This type of headache consists of constant pressure or tenderness over the sinus areas including the cheekbones, forehead and nose. The defining factor of a sinus headache is the presence of nasal discharge, congestion, facial swelling, ear sensations or fullness and in many cases a fever. Treatments for sinus headaches can include decongestions, pain relievers or antibiotics in the case of an infection.

Cluster Headaches: This type of headache is the least common type of “headache” and its cause is unknown. Cluster headaches reoccur over a period of time. Periods can last for several weeks to months then disappear. Each attack is short lasting, severely painful and typically localized to one side of the head. There are no warning signs for a cluster headache. Treatments are available through your health care professional.

Migraines: Migraines are less common than tension headaches. Migraines can last from four to 72 hours on average. Symptoms of a migraine include moderate to severe pain affecting daily activities, nausea, vomiting, light and sound sensitivity and aura. Aura is a warning symptom that can occur before, during or after the onset of a migraine, consisting of blurred vision, blind spots, flashing dots or lights and other visual disturbances. Aura’s typically last 20 to 30 minutes.

More than 29.5 million Americans suffer from migraines, with women being affected three times more often than men. One of the reasons women are affected more by migraines is because hormone changes serve as a migraine trigger. Many women experience migraines before or during their menstrual cycle.

Identifying a Migraine

The ID Migraine Questionnaire, developed by Dr. Richard Lipton, is a simple three question test used to determine if you’re suffering from migraines or another type of headache. According to his research, if two of the three criteria are present, a migraine is likely 93 percent of the time, and if all three are present a migraine diagnosis is 98 percent likely.

• In the last three months, how disabling are your headaches; do they interfere with your ability to function? (Are you missing work, school and family activities?)
• Are your headaches ever associated with nausea?
• Are your headaches ever associated with sensitivity to light?

Migraines are often misdiagnosed as sinus headaches since they have similar symptoms. According to the American Headache Society Committee on Headache Education, 90 percent of the time a self-diagnosed sinus headache is a migraine. Less than half of all migraine sufferers have received a diagnosis of migraine from their health care provider. If you have headaches that continuously interfere with your daily life and that don’t respond to over-the-counter medicines, you may be suffering from migraines. Visit your health care professional to get the proper treatment.

Strategies for Living with Migraines

Migraine sufferers vary in their sensitivity to specific foods, and triggers to foods may take anywhere from 30 minutes to 72 hours to develop, making them often very difficult to pinpoint, says the National Headache Foundation. Experts recommend keeping a daily journal of food intake and activity can help pinpoint specific triggers. By doing this you may be able to determine a pattern and prevent future migraines. This can be time consuming, but is helpful to both you and your health care professional when determining the right course of treatment for you.

The second strategy is preventing and coping with your headaches through lifestyle change. Several triggers are out of your control including the weather, travel and odors such as cigarette smoke, but many common triggers can be controlled by adapting certain habits. Long Beach Memorial encourages you to focus on the common triggers, such as, sleep, diet, exercise, hydration and stress management.

Sleep – Feeling well-rested may keep a headache at bay. It is ideal to get eight hours of sleep each night. Try not to sleep in too late on the weekends and sleep too little on the weekdays. Make it a habit to go to bed and wake up at regular times all week long.

Diet – Keeping your meals routine also can help you avoid headaches. Delaying or skipping meals can cause your blood sugar to dip, causing the “hungry headache.” To avoid this, you should eat balanced meals throughout the day. The best diet consists of as many fresh foods as possible. You should include a good protein source at each meal/snack (i.e., milk, meat, fish) and should avoid eating high sugar foods by themselves, says the American Headache Society Committee on Headache Education. Alcohol and caffeine both can be triggers for headaches; each should be used in moderation.

Exercise - Exercise can help you fight other headache triggers such as anxiety, poor sleep, sadness, stress, and waist and weight gain. Aerobic level activity leads to an increase in natural body joy and pain control chemicals according to the American Headache Society Committee on Headache Education. However, too strenuous of exercise also can lead to a headache. Moderation is the key. For proper walking techniques visit MemorialCare.org/LiveHealthy.

Hydration - Dehydration is a risk for a headache. Weather is a headache trigger, so hydration is especially important on hot days. Prevent dehydration by drinking plenty of water.

Stress - Stress is the most commonly recognized trigger of headaches says the National Headache Foundation. Anything that increases your emotional and physical stress level can trigger a headache. Factors related to stress include anxiety, worry, shock, depression, excitement and mental fatigue. You can’t always avoid stress, but you can alter the way you respond to it. For more tips on stress management visit MemorialCare.org/LiveHealthy.

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