Consumer Reports examines Botox as a remedy for headaches, back pain, tremors

Tuesday, April 6, 2010; HE02

You've heard about Botox (botulinum toxin) as a wrinkle eraser, but as a headache remedy?

Doctors are giving the injections -- basically low doses of a powerful natural poison that relaxes overactive muscles -- for headaches and other problems even though there's scant research supporting their actions. This "off-label" use of Botox and related products such as Myobloc and Dysport has increased significantly.

Those injections are legal, but they're not approved by the Food and Drug Administration. (Botox is approved for treating some wrinkles, severe underarm sweating and other ailments.) Should you try them? The experts at Consumer Reports Best Buy Drugs, which assesses the safety, effectiveness and costs of medical treatments, looked at a few off-label uses:

Headaches. Botox has been used to treat migraines and tension headaches. But the American Academy of Neurology (AAN) says that despite the drug's popularity for these problems, it's actually ineffective for migraine headaches and unlikely to help tension headaches.

Overactive bladder. Several studies have shown that Botox injections in the bladder might reduce urinary incontinence.

Writer's cramp. Shots in the hands might help relieve cramps and spasms if physical therapy doesn't do the trick.

Voice abnormalities. This unapproved use of Botox and related products is a first-choice treatment among doctors for vocal cord palsy, spasms that produce a strained or tremulous voice.

Back pain. While some people may find relief from their back pain with the injections, the evidence is relatively weak, according to the AAN. But at least one study suggests that the injections may relieve low-back pain that's predominantly on one side.

Esophageal spasms. The injections appear to reduce such symptoms as regurgitation, difficulty swallowing and accompanying upper chest pain. While not as effective as surgery or dilating the esophagus, they may be an alternative for people who want to avoid the more serious risks of those procedures.

Excessive sweating. Several small studies have found that the toxin reduces hand sweating and facial sweating that occurs during eating.

Drooling. Some evidence suggests that the shots may control excess salivation in people with Parkinson's disease and amyotrophic lateral sclerosis, or ALS.

Hand tremors. The injections probably improve tremor severity but may also result in finger weakness. They might be considered if medication fails.

Spasticity. Good evidence supports the benefits of botulinum toxin for lower-limb spasticity associated with cerebral palsy in children and for upper-limb spasticity associated with strokes in adults. The injections especially improve the gait of children with tightened calf muscles. In adults, they were found to be safer and more effective for upper-limb spasticity than a first-line medication, according to a 2009 study published in the Journal of Neurology, Neurosurgery and Psychiatry. The toxin is thought to be similarly effective for adult spasticity due to multiple sclerosis or brain or spinal cord injuries.

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What are the risks with botulinum toxin? Serious though uncommon reactions have occurred when the toxin has spread from the injection site to other muscles, resulting in general weakness, the need for a respirator and, in rare cases, death. Case studies have described another side effect, also rare: muscles losing their tone from injections around the temple area, resulting in an "hourglass" deformity. Predictable side effects include pain and bruising at the injection site, temporary weakness of the injected muscle, headache, nausea, neck or back pain, dry mouth, and dry or irritated eyes.

What precautions can you take? Seek treatment from a specialist for your condition, such as a board-certified dermatologist or neurologist, and ask about his or her experience with the toxin. Tell your doctor if you have heart disease or a disease in which communication between nerve and muscle is damaged, such as ALS or myasthenia gravis; what medications and dietary supplements you take or plan to take, especially antibiotics, drugs for Alzheimer's disease, or any other botulinum toxin treatment you've had in the last four months; and if you are pregnant, trying to become pregnant or if you are nursing.

Copyright 2010. Consumers Union of United States Inc.

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