It is very exciting to finally have two published studies (PREEMPT 1 and PREEMPT 2) which provide definitive proof that Botox is effective for chronic migraine headaches.  More than 15 years ago a plastic surgeon in California, Bill Binder reported that many of his patients treated with Botox for wrinkles found relief from headaches.  Everyone was very skeptical, but having many patients who failed every other treatment and having learned that Botox is very safe if used properly, I decided to try it.  To my great surprise Botox worked exceptionally well.  My most dramatic experience was in a 76-year-old woman who suffered from daily headaches for 60 years.  She had failed a long list of medications, nerve blocks, acupuncture and other treatments.  After the first Botox treatment, for the first time in 60 years she went for three months without a single headache.  Her neurologist came to my office to learn the technique I developed and has been using Botox in his practice ever since.  More than 200 doctors from around the world came to our Center to learn how to use Botox for headaches.  They were all searching for new treatments for their desperate patients.  At the same time most of the medical community had remained very skeptical and dismissive of this approach.  They could not believe that Botox could help headaches and wanted to see double-blind, placebo-controlled trials before using it in their patients.  Well, now they have it, but over the past 15 years many of their patients could have benefited from this safe and effective treatment.  Yes, we do need proof that any new treatment works, but when this treatment is safe and there are no better alternative, it is appropriate to try it before definitive proof is available.  We hope that these two studies will lead to the FDA approval of Botox for the treatment of chronic migraines before the end of 2010, which will make it easier for patients to obtain insurance reimbursement.