Defeating Pain

One Person's Battle Against Chronic Pain


Botox? Isn’t That Just For Wrinkles?

Botox, I am sure everyone has heard of this. I get Botox injections for therapeutic reasons, to treat my migraines. But often when I mention this to someone I get the response of “But you are so young?” or “But you don’t have wrinkles?” Which while slightly amusing, shows that the most well known uses of Botox are for cosmetic and not therapeutic reasons. I have also been asked by other people who suffer from migraines themselves how well this works, so I figure why not throw some light on this well-known, but not well understood by most of the populace, treatment.

When you hear about Botox, it is mostly tied with famous for movie stars, known for making them look like slightly puffy, wooden people since their faces are so paralyzed with Botox they can’t form normal expressions. Some are more honest about it. Like Joan or Dolly, who are open about their use of not only Botox but all things plastic surgery. Which I respect that they are open to saying basically, “Yeah, none of this is natural but I have to perform so it sort of is required with the gig.” Also, I mean come on, if they lied we would know.

Am I smiling? I can’t tell if I’m smiling…

Then you have the ones that think nobody notices that they had a lot of work done, especially with Botox.

Yikes. This is what happens when you can’t feel your face, not good.

But Botox was not originally invented to help celebs not have sweaty armpits at events like the rest of us normal people, or to make them not look, as Joan put it, Shar peis. It was noted as a possible way to help instead of harm people pretty much from its first moment of “discovery.”

So what IS Botox? Most people have heard of it but few really know what it is. Botox is the brand name for a “safely” inject-able form of the botulinum toxin, which causes botulism. You may have heard of botulism, it is why there is a lot of suspicion around home-canned goods as well as why you want to avoid dented cans if you purchase canned goods. This neurotoxin, which means it only has an affect on the nervous system, and causes muscle paralysis which is why it is so highly sought by movie stars. The extreme paralysis makes wrinkles from facial expressions impossible, thus giving the illusion of youth, emphasis on illusion.

Botulinum toxin was first discovered in Germany and information was published on it between 1817 – 1822 by Justinius Kerner, the poet and medical writer. He called it “sausage poison” or “fatty poison” due to it being found generally in poorly prepared sausages, or fatty meats, that caused deaths frequently in his time. He was the first one to notice that this paralytic neurotoxin might have a therapeutic use, despite its deadly nature. He also coined the name botulism, from the Latin botulus meaning “sausage,” since sausages are what were generally poisoning people due to poor hygiene in some rural production. Which they do look like little fat sausages…

little, fat, murderous sausages.

In 1895 it was a Belgian bacteriologist, Emile van Ermengem, who isolated the bacteria that causes botulism from a piece of fatty smoked ham that had poisoned thirty four people at a funeral dinner. He named it Colstridum botulinum, since it looked very sausage like under the microscope. Luckily, it is now known that to kill the bacteria food must be heated to at least 185 °F (or 85 °C) for 5 minutes or more to kill the bacteria. Which is why during canning processes the cans, once sealed, are heated to kill off bacteria. There are other ways of getting infected with the bacteria that causes botulism, it can be contracted through inhalation, wounds (most commonly in people that inject drugs on the street), it even lives in certain soils. But ingestion was the most usual way to become infected with this deadly bacterium for many years of human history. Now death is much less common with modern antibiotics, as long as treatment is sought soon enough. Other animals can be affected by this bacterium, and it is well known to affect bird species. Botulism is also a reason why honey is not recommended for children under the age of 1, since spores of the bacteria can live in honey and cause floppy baby syndrome.

Then in 1928 P. Tessmer Snipe and Hermann Sommer first purified the toxin, that means they were able to isolate the toxin from all the other stuff produced by the bacteria. Which means, like being able to isolate penicillin, this was now a manufacturer-able toxin. Then with the purified toxin another group of scientists, Arnold Burgen’s group, working in 1949 was able to find that the botulinum toxin was blocking neuromuscular signals by preventing or decreasing acetylcholine release. That means that it is effectively muting the signals from your nerves telling your muscles to move, and that isn’t just the muscles that move your body (the skeletal muscles) but all of them. That means the ones that make you breathe, swallow, blink, make your heart beat, all that involuntary stuff your body does without thinking. Which is really bad news, since your whole body functions off the movement of muscles, and all that becoming impossible. A pretty scary thought right?

“And people willingly inject themselves with this?!?!?” you must be saying.

Sure do. There are a few different types of toxins produced by the C. botulinum, and they are labeled A through H, and it is the Botulinum toxin type A that is known as Botox (or sometimes as Dysport or Xeomin) that is the most commonly used for therapeutic and cosmetic purposes. There is another form available MyoBloc made from type B that seems to be less commonly used, but still for both therapy and cosmetic reasons.

And this is what that Botulinum toxin type A looks like

It was in the 70’s, more precisely 1973, that an opthamologist (eye doctor) Alan Scott and Edward Schantz, in San Francisco, started doing experiments with the type A toxin on monkeys, and eventually developed a treatment method for humans. In 1980 the first human was injected with the toxin to treat crossed eyes and later was used to treat uncontrollable blinking. In 1993 it was used to treat spasms of the lower esophageal sphincter, and in 1994 it was shown to inhibit excessive sweating (something later made famous by celebs not wanting to sweat at events we mentioned earlier). There were many other uses that it was found to be helpful with both cosmetic and therapeutic, but it was not until October of 2010 that the FDA approved the use of Botox to treat chronic migraines.

And there was much rejoicing.

Speaking as a chronic migraine sufferer, Botox is just about the coolest thing out there. I have had so many different procedures to treat my migraines, and nothing gives the results that Botox does. For me I have gotten 3 months, and sometimes a bit more, of migraine free life. Which is a glorious thing, after you have spent months and months having maybe a handful of days where you didn’t have a migraine. It doesn’t require as often an application (at least for me) as corticosteroids, and I find the relief levels are much greater and my use of prescribed medications, or other medications, significantly reduced. In some ways this was my “miracle drug” for me. (Now, everyone is different so your results may be different, and Botox could even be not the best thing for you. Always discuss any treatment decisions with your doctor.)

But this is not something to be treated lightly, Botox can have significant side effects. Listed in depth on the medication guide and product information on Allergan’s (the maker of Botox) site for information on Botox for migraines. Reading these may scare you off the treatment all together, which in some ways is a good thing. It seems to be all too commonly used for cosmetic purposes, since most people think it is “safe” and won’t cause any issues. While it is a diluted form of the toxin, and has been ruled safe to use by the FDA that does NOT mean that you can just go to any old place and get it injected. There are a lot of places that offer Botox cosmetic injections, which if done improperly you can end up looking a lot worse than Madonna does. It could cause serious side effects and even death if done wrong and left untreated. So make sure that if you are opting for this treatment that you really need it first of all, and second of all you are getting the injections from a physician and not some lady in a salon who doesn’t even have a GED. This is a neurotoxin, that killed 1000’s before we were able to identify it. Toxin’s are not good for you, and you only want to go this route if you have to. Seriously, be smart about this stuff. You wouldn’t go up and piss off a rattlesnake just for fun, so don’t let just anybody shoot you up with neurotoxins, ok?

If you do suffer from chronic migraines, this may be your miracle drug too, you should definitely discuss it with your doctor and make sure they aren’t doing this as a first option. Second opinions are always good, but if you have ruled out all other treatments and causes of migraines this may be the best option out there for you.

ProInsuranceTip: One of the big issues I run into is the usual insurance coverage issues, which if you are a chronic pain sufferer you are probably well versed in all the fun things you have to do to get them to approve things. This should be covered under “good” insurance, but may not be. Botox is extremely expensive, so that may be a prohibiting factor in its use for you. See what you can work out with your doctor if you are not covered for it.

Remember, we are all different and some treatments that work for others may not work for you. Make sure you discuss all options with your doctor, and that you both agree that this is the right treatment for you and your symptoms. Educate yourself on it, make sure you know all you can, if you are ever in doubt about any procedure, Botox or otherwise, ask a professional!