One Side Effect of Botox: An Excruciating Headache


Botox is remarkably safe, especially considering it’s a powerful toxin. Occasionally, a mild headache that lasts a few hours may occur after an injection in muscles of the forehead. Very rarely, though, that headache may become excruciating and can last as long as a month. While only about 1% of 320 Botox users in a recent study experienced the more severe side effect, more reports may surface after physicians learn about it from reports published in the Journal of the American Academy of Dermatology.

“What was surprising was how long the headache lasted and that nothing seemed to give much relief,” says Kenneth A. Arndt, clinical professor of dermatology at Harvard Medical School and a co-author of the study. He says no one knows why Botox, which can effectively treat migraines in some people, would actually cause headaches. “It may be because of a disequilibrium in the muscles,” Arndt says. “Some muscles are relaxed and others tighten.”

He doesn’t think the severe headache after Botox injection is a coincidence but says that further studies are needed to confirm the link and investigate the possibility of a placebo effect. If a severe headache does occur after an injection, Arndt suggests not having Botox again. For those who don’t want their frown lines to reappear, he says Myobloc, which is botulinum toxin type B, is worth a try. (Botox is botulinum toxin type A.) “The person can be injected with a few drops [of type B] and see if the same thing happens,” he says. (Journal of the American Academy of Dermatology 46 [1]; 62-65.)

Muscle Building Burns Calories Only to a Certain Extent


Build muscles and burn more calories even while you sleep. That common belief is not exactly a fitness lie. Let’s just call it a misinterpretation.

A recent study showed resistance or strength training builds muscle, which increases resting metabolic rate, so more calories are burned after you stop exercising, but that effect doesn’t last longer than about 72 hours. The only way to burn more calories is to keep exercising, said the author of the recently published study.

After six months of working out regularly with a personal trainer, women in a resistance training group increased their fat-free mass--that includes muscle--and their resting metabolic rate, but there was no change in the total calories burned in the days following the end of the study. “The total calories used each day increases a little but it’s short-lived. It lasts about 48 to 72 hours,” says Eric T. Poehlman, a professor of nutrition and medicine at the University of Montreal. If you want to burn more calories than you do in your usual daily activities, he says, “you’ve got to keep exercising. There is no carry-over.”

Those in the endurance-trained group who did aerobic exercise with a trainer increased their lung capacity, but they had no change in their fat-free mass or the number of calories burned doing their treadmill workout or in the days afterward. (The Journal of Clinical Endocrinology & Metabolism 87 [3]; 1,004-1,009.)

Folate May Benefit People at Risk for Colon Cancer

There’s nothing you can do to alter the genetic cards you’re dealt at birth, but evidence is mounting that you can modify the risk dictated by those genes.

Recently, for instance, researchers found that consuming more folate and less alcohol significantly lessens the chances that a person with a family history of colon cancer will get the disease. A person whose parent or sibling has colon cancer has twice the risk of developing it. That increased risk can be virtually eliminated, researchers found, by taking a multivitamin with 400 micrograms of folic acid (folate) and drinking no more than a glass or two of wine a day.

They came to this conclusion after studying the diet, supplement use and drinking habits of nearly 90,000 women for 16 years. The women were participating in the Nurses’ Health Study, a group of 121,700 female nurses whose health and habits have been followed by researchers for 25 years. The researchers also report in the journal Cancer Epidemiology, Biomarkers and Prevention that high levels of folate and methionine, an amino acid, and low levels of alcohol had only a small effect on colon cancer risk in women with no family history.


Fruits, vegetables and products made with enriched flour are good sources of folate. Dr. Charles S. Fuchs, of the Dana-Farber Cancer Institute in Boston, said it’s easiest to be sure you’re getting enough folate by taking a daily multivitamin, which is what many of the nurses in the study did. (Cancer Epidemiology, Biomarkers & Prevention Mar; 11 [3], pp 227-234.)

Research Links Nausea to Anxiety and Depression

When a queasy stomach can’t be traced to something you ate or the flu, think about what’s going on in your head. People who suffer from anxiety or depression frequently have gastrointestinal complaints, particularly nausea, according to a new study. Earlier studies show most people seeing specialists for gastrointestinal disorders have anxiety and depression. However, researchers didn’t know how prevalent the link was in the general population.

To find out, they surveyed more than 60,000 adults living in Norway about symptoms such as nausea, heartburn, diarrhea and constipation. A test for anxiety and depression was also conducted. The Norwegian team concluded that anxiety was the strongest risk factor for mild to major nausea. Four out of 10 people who had major complaints of nausea had anxiety. About one in four had depression. Of course, some of the people who had anxiety and depression may have also had physical conditions, such as angina or cancer, which could cause nausea. But the researchers say these health problems couldn’t account for all of the nausea reported.


“This study announces to doctors that when a person comes in with stomach distress, at least stress and anxiety ought to be considered before doing a lot of tests,” says Don R. Lipsitt, editor of General Hospital Psychiatry and professor of psychiatry at Harvard Medical School. (General Hospital Psychiatry 24 [2002]; pages 81-86.)

Glycemic Index Charted for Fitness Drinks, Snacks

By now, if you don’t know all carbohydrates are not alike, you’ve either been living far from the Zone diet or you don’t have a weight problem. Glycemic index, buzzwords for how quickly glucose from a carbohydrate gets into your blood, is being bandied about like fat grams.

Dieters are urged to avoid too many carbohydrates, especially those with a high glycemic index because they send blood sugar levels soaring. That sets off a series of reactions that contribute to weight gain and diabetes. The glycemic index of hundreds of foods has been charted, but until now, sports drinks and energy bars haven’t been analyzed. The results of a study that involved more than 1,000 finger sticks to test the blood sugar levels of five volunteers were published in March in the Journal of the American Dietetic Assn.


Glucose, the sugar that results from the breakdown of starches and circulates in the blood, is the standard by which the bars and drinks were measured, says Randall J. Gretebeck, a Wayne State University dietitian and exercise physiologist. The glycemic index of glucose is 100, marking the top of the list.

Neck and neck with glucose was a Cookies & Cream Cliff Bar. A bar with a high glycemic index is not a bad thing after a vigorous spinning class or an arduous uphill hike. After a long and strenuous workout, there’s a two-hour window of opportunity when muscles refuel more quickly, Gretebeck said. But a food with that high an index isn’t the healthiest afternoon snack if you’ve been sitting at your computer all day and haven’t used your stored energy.

Orange Allsport sport drink and vanilla Boost meal replacements were lowest on the glycemic index list. The Met-Rx bar was the lowest of the energy bars. “Some people believe lower glycemic index foods are best before an endurance activity because they raise the blood sugar more slowly before beginning exercise and keep it more steady,” Gretebeck says.



Dianne Partie Lange can be reached by e-mail at