The word, Botox, always elicited a specific scene in my mind: the scene from “A Cinderella Story (2004)” with stepmom, Jennifer Coolidge and her plastic, wrinkle-free face. After working in a neurology clinic, I realize that Botox is more than the smooth, frozen face. In order to discuss the differential properties of Botox, we need to evaluate its medical development as a treatment.
Botulinum toxin type A (Botox®; Allergan Inc) is indelibly associated with its cosmetic value in temporarily preventing the appearance of wrinkles by relaxing the facial muscles. Botox paralyzes muscles by cleaving SNARE proteins, which then inhibits the release of acetylcholine, and results in temporary muscle paralysis. Interestingly, this cosmetic treatment was not the initial reasoning for Botox’s inception. In 1989, Botox was FDA approved to treat strabismus, a medical condition where the eyes are not lined up in the same direction (Escuder & Hunter, 2019). With the administration of Botox, the eyes become aligned by paralyzing individual eye muscles (Scott, 1980). The concept of paralyzing muscles was further researched in clinical trials for the aesthetic treatment of Botox (Frampton & Easthope, 2003). In 2002, the FDA approved Botox to temporarily improve the look of moderate to severe crow’s feet, forehead lines, and frown lines in adults.
Research for therapeutic treatments of Botox did not stop there. Patients who received botox in the face reported improvement in headaches. A 2000 study by Silberstein et al. found that Botox significantly reduced migraine frequency and severity. As a result, Botox became FDA approved in 2010 for the prophylactic treatment of United States’ second most debilitating disease, chronic migraines. Chronic migraines are characterized as ≥15 headache days/month or ≥ 8 migraine days/month with each episode lasting >4 hours (Lipton, 2011). Decrease in chronic migraine severity and frequency can last for up to 10-12 weeks with botox as the consistent line of treatment.
Botox is now indicated for chronic migraines, strabismus, bladder dysfunction, blepharospasm, cervical dystonia, adult spasticity, severe primary axillary hyperhidrosis, and pediatric upper limp spasticity. This one toxin is an example of beneficence. It is incredible that Botox is approved for a multitude of medical conditions and is considered as both aesthetic and therapeutic lines of treatment. Further research should be done to investigate if there are more therapeutic effects of Botox for existing medical conditions. Looking better in the wrinkle department is not the only thing Botox can do.
References:
Escuder, A. G., & Hunter, D. G. (2019). The role of botulinum toxin in the treatment of Strabismus. Seminars in Ophthalmology, 34(4), 198–204. https://doi.org/10.1080/08820538.2019.1620795
Frampton, J. E., & Easthope, S. E. (2003). Botulinum Toxin A (Botox® Cosmetic): A Review of its Use in the Treatment of Glabellar Frown Lines. American Journal of Clinical Dermatology, 4(10), 709–725. https://doi.org/10.2165/00128071-200304100-00005
Lipton R. B. (2011). Chronic migraine, classification, differential diagnosis, and
epidemiology. Headache, 51 Suppl 2, 77–83.
610.2011.01954.x
Scott A. B. (1980). Botulinum toxin injection into extraocular muscles as an alternative to
strabismus surgery. Ophthalmology, 87(10), 1044–1049. https://doi-
org.dml.regis.edu/10.1016/s0166420(80)35127-0
Silberstein S, Mathew N, Saper J, Jenkins S, & BOTOX Migraine Clinical Research Group.
(2000). Botulinum toxin type A as a migraine preventive treatment. Headache: The Journal of Head & Face Pain, 40(6), 445-450.
Thank you for sharing this insight! I seems like you can get a "two for one" method when it comes to botox for helping with headaches and great wrinkle free skin. I also found some research that allowed hypertrophic scars and keloids to become significantly less (Frankel, 1999). It is still very much unknown however the research suggests that the botox helps with scar tension as well as enhancing action of collagen and fibroblasts. This would be an incredible add to surgical practices to help limit scaring and keep the integumentary system similar to how it was before any procedures were performed or injuries occurred!
ReplyDeleteKasyanju Carrero, L. M., Ma, W. W., Liu, H. F., Yin, X. F., & Zhou, B. R. (2019). Botulinum toxin type A for the treatment and prevention of hypertrophic scars and keloids: Updated review. Journal of cosmetic dermatology, 18(1), 10–15. https://doi.org/10.1111/jocd.12828
Frankel A. S. (1999). Botox for rejuvenation of the periorbital region. Facial plastic surgery : FPS, 15(3), 255–262. https://doi.org/10.1055/s-2008-1064325
I really enjoyed reading about this, considering I have heard about this theory, but wasn't sure if it was true or not. As someone who has suffered from bad migraines earlier in life, I wish I had known about this theory. I have also done research about other theories that help with migraines, such as getting a daith piercing(your daith is the smallest fold of cartilage in your ear.) Although this theory isn't as advanced as the botox theory, there is some good information on it provided by the American Migraine Foundation. The daith piercing has more risks than rewards, such as the effects only being temporary, and risk of pain and infection. Based on the data, it seems as though botox is the better option and seems to show great results.
ReplyDelete“Daith Piercings as Migraine Treatment.” American Migraine Foundation, 8 Nov. 2019, https://americanmigrainefoundation.org/resource-library/daith-piercings-101/.
ThuyVi,
ReplyDeleteI know we have talked about the use of Botox for migraines, as I do suffer from migraines. I have considered getting Botox after our several in person conversations. However after reading this post, I really think it is a path that I may want to consider. This is especially since many preventative treatments need to be taken daily and Botox lasts 10-12 weeks. Furthermore, these preventative treatments have really bad side effects. I have also researched the benefits of acupuncture in combating migraines. Acupuncture is very useful when treating migraines as it reduces duration and frequency. I wonder if there would be any benefit to pairing Botox and acupuncture in migraine treatment?
Urits I, Patel M, Putz ME, et al. Acupuncture and Its Role in the Treatment of Migraine Headaches. Neurol Ther. 2020;9(2):375-394. doi:10.1007/s40120-020-00216-1