Botox may offer new hope for patients with low cerebrospinal fluid headaches

A Mayo Clinic case study finds Botox may offer new hope to patients suffering disabling low cerebrospinal fluid headaches. The successful treatment also offers new insight into Botox and headache treatment generally. The case study was presented March 13th, 2011 at the American Academy of Neurology meeting in Hawaii.

Low CSF pressure headaches are caused by an internal spinal fluid leak. The pain can range from slight to disabling. The headaches are most commonly triggered by a lumbar puncture. The pain is caused as fluid leaks out and the brain sags. For many patients, lying down has offered the only relief, because existing therapies weren't fully effective. Traditional treatment is a blood patch, which is just that: a patch of the patient's blood injected over the puncture hole.

The patient in the case study suffered low CSF pressure headaches for 25 years. For most of that time, she only felt better while lying down, curtailing her day-to-day activities. Five years ago, she sought help from Michael Cutrer, M.D., and Paul Mathew, M.D. The patient has received Botox for three years and the results have been consistently positive. After each treatment, improvement would last for three months before pain returned, requiring another dose. While not cured, the patient is now able to live a more normal life.

"We had been using Botox for several years for treatment of migraine and had been successful in many patients. And because we really didn't have anything else to offer her, we gave her the Botox," says Dr. Cutrer, a neurologist at Mayo Clinic in Rochester, Minn., and the report's co-author. "To everybody's surprise she made a remarkable improvement." The intensity of the patient's headaches dropped from 8 out of 10 on a visual pain scale to 3 out of 10.