If ibuprofen isn't enough to quell chronic headaches, there's always Botox.
Since the Food and Drug Administration approved Botox injections last fall as a therapy, more patients are experiencing substantially fewer and milder migraines, local doctors say.
"Just in the last six months, it's become more popular" as more insurance companies are covering it, said Dr. Scott Goodman, a neurologist at the Nebraska Medical Center.
"It's a very helpful treatment for our patients," he said. "It's just that the medicine itself is expensive." But now that the FDA backs it, more insurance providers assume at least some of the cost.
Medicare, Medicaid, Coventry Health Care of Nebraska, UnitedHealthcare and TRICARE all cover Botox treatment for migraines, Goodman said, though some require prior authorization, deductibles or a co-pay.
Blue Cross Blue Shield of Nebraska does not cover the treatment. Chief medical officer Bill Minier said in a written statement that the treatment is not scientifically validated. No one was available to comment on why the insurance company's position differs from the FDA.
A plastic surgeon first discovered Botox's potential as migraine relief roughly 15 years ago after patients who received cosmetic injections reported fewer headaches. His finding didn't surprise doctors who already used Botox to treat muscle spasms, said neurologist Diego Torres-Russotto of the Nebraska Medical Center.
Neurologists believe Botox paralyzes the sensory receptors in the scalp, making people less sensitive to headache pain. The treatment does not cure headaches but decreases their severity and frequency.
Casie Lanning, 32, of Bellevue, began battling chronic migraines in high school.
"They would get to the point where I couldn't function. I couldn't think. They would cause me to be physically sick," she said.
Black and white spots clouded her vision during the near-daily episodes. Migraines would strike with such strength that she routinely visited the emergency room.
"It felt like my brain was trying to claw its way out of my head," she said.
For years, Lanning tried different pill-based medications to no avail. Then, in February, she received her first Botox treatment at the Nebraska Medical Center.
Goodman, her doctor, injected 31 shots into Lanning's forehead, temples, neck and upper back. Lanning said she was skeptical the treatment would work, but within two weeks, her headaches subsided.
She received another treatment a couple of weeks ago, her second in six months. It took 13 minutes and 155 units of botulinum toxin, the same compound that smooths wrinkles and fine lines.
Yes, smoother skin is a common side effect, Torres-Russotto said. But "we don't do it for the wrinkles," he laughed.
Dr. Karen Bremer, a neurologist at Creighton University Medical Center, estimates one treatment costs roughly $1,500.
The price turned a lot of people off, she said, but it's no longer cost-prohibitive if you have the right insurance. Bremer said she administered Botox injections to a couple of patients each month before the FDA approved it as a treatment. Now, she sees multiple migraine patients a week.
A handful of doctors treat migraines with Botox in Omaha. Chronic migraine patients can receive one treatment every three months. Those who qualify must experience a combination of migraines and less intense headaches for 15 days of each month.
They must also have exhausted other therapies, Bremer said.
"It's a rescue medication when patients have failed everything else," she said. "And it's the best one I've got."
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