When Robyn Forman turned 40, the extra lines on her face were the least of her cares. So her friends were surprised when, a few months later, she started going for regular Botox treatments.

But Robyn wasn’t using the popular wrinkle remedy to smooth out her skin. She was getting the injections to treat a more worrisome problem: increasingly frequent and intense migraines.

Migraines are debilitating headaches often experienced on one side of the head that cause extreme sensitivity to light and sound, nausea and even vomiting. One headache can last as long as three days. For years, Robyn's headaches were painful, but manageable. After she turned 40 however, they became so bad she felt like they limited her daily life—with little relief in sight.

Medications, such as topiramate (Topamax) to prevent migraines, and sumatriptan (Imitrex) to halt an impending attack, usually have minimal side effects, but they made Robyn feel so “loopy” that she often felt incapable of driving herself home from work. She was then prescribed antidepressants, which may help reduce the frequency of migraines for some, but they left Robyn feeling suicidal, though that is a very rare side effect.

“I was afraid to try any more pills, but I was getting more migraines and they were becoming more severe,” Robyn, now 42, of San Ramon, CA, says.

Some desperate Internet searching led Robyn to an article about people with migraines who’d experienced relief after using botulinum toxin type A (botulinum A), aka the active ingredient in Botox. Soon, the woman who calls herself “a big baby when it comes to needles” was sitting in a neurologist’s office being injected 15 times in her forehead with Botox.

The needles hurt, but the results were worth it, Robyn says. “The relief was almost immediate. I would wake up and see the spots that told me I had a migraine, but I did not feel the pain.”

Robyn now only needs Imitrex if she gets a migraine as the Botox wears off in the waning weeks before her next injection. She hasn’t experienced any side effects from the Botox, nor does she feel uncomfortably numb.

Botox’s effects on migraines were discovered accidentally. In 1992, patients visiting plastic surgeons to smooth out their wrinkles started reporting that they had fewer migraines. Several studies have been done in the years since, and in the largest study to date, severe sufferers (people with 15 or more headache days per month) experienced an average of about eight fewer pain-filled days after treatment. People with less frequent migraines do not have similar success, says Mark W. Green, M.D., professor of neurology at Mount Sinai School of Medicine in New York City, indicating that the treatment works best in people who suffer from frequent migraines.

In Robyn's case, the results have been stellar, but Botox is far from a magic bullet for migraine sufferers, says Dr. Green. Doctors don’t yet completely understand how botulinum A works to relieve migraines, but they do believe it goes beyond simply relaxing the forehead muscles. “There are sensory fibers which go from the scalp right to the skull and right onto the top of the brain,” says Dr. Green. “We believe [botulinum A] blocks those fibers. So, in some ways, what we are doing is a nerve block into the brain.”

No botulinum medications (Botox, Myobloc or Dysport) are approved by the U.S. Food and Drug Administration (FDA) for the treatment of migraines yet. Currently Botox is only approved for the treatment of cervical dystonia (involuntary neck muscle contractions), certain eye muscle problems, excessive underarm sweating and cosmetic treatment for a “furrowed brow.” But that might change soon; Botox manufacturer Allergan recently announced plans to petition the FDA for approval.

Dr. Green says that up to half of his migraine patients with frequent attacks could be candidates for Botox treatment, but the cost of the procedure presents a problem. “The fact is that we’d use it on a lot more patients, but they can’t afford it,” Dr. Green says. “It’s very expensive, and frequently, insurance companies won’t cover it.” One dose of the medication can cost about $500 to $600, and that doesn’t include the additional injection costs that might be charged by your doctor. If the FDA approves the drug for migraine treatment, patients may be eligible for coverage, though insurers would not be required to cover the cost. (Robyn wrote a letter to her insurance company asking for coverage of her treatments. The company agreed to cover one treatment every 90 days.)

But for some sufferers, like Robyn, it’s worth every penny. She says even if she didn’t have insurance coverage, she would find a way to pay for the treatment because it has been so effective. “I’m no longer lying in bed and saying to my husband, ‘Sorry, you have to cancel plans with our friends because I don’t feel good,’” Robyn says. “My life is hugely different.”

People are talking about it on the iVillage Message Boards:

• “I go in for a Botox consult next week!”
• “There’s a 60 percent chance of my insurance covering it.”