According to TIME medical correspondent Dr. Ian Smith, there are doctors out there who will give migraine sufferers an “off-label” Botox injection. “Even though the FDA hasn’t approved Botox for treatment of migraines, some neurologists and anesthesiologists will prescribe it to patients, as long as patients know the treatment isn’t officially approved,” says Smith. How does the treatment work? “No one really knows for sure, but since Botox is a paralytic agent, some doctors think it may interrupt the neurogenic pathways involved in migraines.” More tests are currently under way to determine the efficacy of various dosages for different types of migraines. In the meantime, Dr. Binder is worried that his discovery could bring throngs of migraine sufferers to his office. “I am not a neurologist,” he told an interviewer. “I don’t necessarily want a zillion headache patients out of this. I do noses.”
Really, what would you rather do: Maintain your ability to exhibit facial expressions or banish migraines forever? Far from the realm of the purely hypothetical, this choice may soon be staring you in the face. The Associated Press reports that Dr. William Binder, an L.A. plastic surgeon, inadvertently uncovered a bold new wrinkle in migraine treatments: Botox. In recent years, plastic surgeons have injected botulism toxin to “freeze” facial muscles, minimizing movement and, of course, wrinkles, in areas like the forehead, nose and around the borders of the mouth and eyes. In the course of treating patients for lines on their faces, Dr. Binder found that those patients with chronic headaches were reporting a lessening or complete cessation of their migraine symptoms. (And they looked younger, too!) Although Botox injections can cost hundreds of dollars, each treatment appears to help ease migraines for up to four months, a drastic savings when compared to traditional migraine maintenance drugs. The $64,000 question, as always, is whether HMOs will swallow the idea of Botox as therapeutic treatment and pay for it, or if they’ll put their collective foot down to head off a run on “migraine treatments” at plastic surgeons’ offices.