Botox (onabotulinumtoxinA) has been approved for the prevention of chronic migraine in adults by the US Food and Drug Administration (FDA). The approval is the culmination of a decade's worth of speculation and research, which was sparked when doctors who use the formulation to reduce facial lines noticed that some patients also experienced a reduction in headaches.

Botox (botulinum toxin type A) took one step closer to being approved for use in the United States. as a preventive treatment for chronic migraines. Botox manufacturer Allergan expressed confidence that a recent request for information from the US Food and Drug Administration (FDA) is a positive sign. Specifically, the FDA asked for an updated Risk Evaluation and Mitigation Strategy on how to safely market Botox for potential anti-migraine use. Allergan has supplied the information, which includes a plan for training healthcare professionals on the use of Botox for chronic migraine. The FDA is taking three months to review the information and expects to make a decision in October.

I have been suffering from chronic daily headaches since I was 13-years-old. I am now 37-years-old. Back then it was tension-type headaches, with a migraine only occurring about 1-2 times per month. I went to see my first neurologist when I was 14-years-old. He literally told me to learn to live with them and that I would out grow them when I was done going through puberty. Unfortunately he was wrong. When I was about 19-20 years old my headaches transformed to severe daily migraines. At that time I was seeing a psychologist, who, when he found out, urged me to go back to a neurologist and assured me I did not have to live like that. That started my journey to seek treatment. I cannot tell you how many doctors I saw throughout the Tri-State area. I lost count. Time and again I was eventually told that they had never encountered a patient like me. Resistant to all medications and treatment, all my tests came back normal. The migraines never improved or lessened. On a scale of 1-10 my headaches, in all these years, has never gone below an 8. They would all tell me there was nothing more they could do for me and I should seek another doctor. At 24 years old I was desperate. I quit my job and struggled to try to deal with these crippling migraines on my own.

I have had headaches all my life. Having kept a detailed diary for five months recently, I now know that I get a headache about 12 days a month often beginning with pain in the blood vessels of my neck. 40% of the headaches resolve themselves within three hours. But 60% of them progress either in severity or duration. One or two days a month a headache becomes disabling. I end up on the couch or in bed most of the day with pain on one side of the head and often vomiting. (I only get a classic migraine, with aura, once every five months and there is no pain to it.) I began taking Propranolol in 1991 and experienced some improvement. Propranolol has a nice side benefit. It makes me calmer and eliminates my panic attacks.

Another entry in the race to develop a new generation of migraine treatments is showing promise. Lasmiditan (also known as COL-144) was found to be effective for acute migraine attacks in a Phase IIb study. CoLucid Pharmaceuticals, Inc. describes the drug as "a first-in-class Neurally Acting Anti-Migraine Agent (NAAMA) designed to deliver efficacy in migraine without the vasoconstrictor activity associated with previous generations of migraine therapy. COL-144 selectively targets 5HT1F receptors expressed in the trigeminal nerve pathway."

Q. I have had migraines for over 20 years. For many years now I have been on a beta-blocker for preventive therapy as I failed to tolerate Imitrex® or Topamax®. My headaches usually begin after excessive stress and fatigue, but can occur anytime. In spite of having a very healthy lifestyle, I still have migraines at least twice a month, which unfailingly last three days. Do you have any other ideas for me?

Treatment options for the severely painful condition called cluster headache are limited. Because triptans are used successfully to treat migraine attacks, researchers from Oxford, England, believed they might also be useful for cluster headache. To determine their effectiveness, they analyzed six well-controlled studies of triptans for the acute treatment of cluster headache episodes.