Botox, extracted from one of the deadliest toxins known to man (Botulinum toxin), has continually astounded the medical world with its seemingly endless applications. Botox has been a staple of cosmetic enhancement for nearly 30 years. Still, its medicinal applications for conditions ranging from persistent migraines and back pain to heavy sweating and twitching eyelids now account for more than half of its sales.
TIME reports in an in-depth cover story that the off-label use of this particular toxin has contributed to Botox’s success. Here are a few of the more unusual Botox applications:
Chronic Migraine (FDA approved)
In 1992, a Beverly Hills plastic surgeon noticed that patients who received Botox for wrinkles complained of fewer headaches. Botox was approved for chronic migraines in 2010 after they tested the drug on people with chronic migraines. Some doctors question whether botox is genuinely effective in treating migraines or whether the placebo effect is to blame.
Patients with chronic migraines who regularly use Botox report having fewer migraines. Antidepressants, anti-seizure, and anti-blood pressure medicines are currently available, as well as other medications that have been discovered to help with migraines by mistake. Botox injections for migraine prevention are now given in 31 locations around the head and neck, with the results lasting three months.
Excessive Underarm Sweating (FDA approved)
When doctors noticed that their patients treated for facial spasms were sweating less, researchers began looking into whether Botox could be used to treat severe primary axillary hyperhidrosis. In 2004, Botox was approved as a treatment. Botox is also used to treat excessive sweating in the hands and feet in some individuals.
Over-active Bladder(FDA approved)
Botox was one of the most effective treatments for overactive bladder that a researcher at a Chicago university had ever seen in his 30 years of medical practice. According to one study, about 70% of women treated with Botox had about three leaks per day, compared to an average of five leaks per day at the start of the study. There is, however, a snag. Botox can cause the bladder to shut down too much, requiring catheter use in some cases.
Being crossed-eyed (FDA approved)
One of the first Botox treatment was for a condition in which the eyes do not line up in the same direction, affecting about 4% of Americans.
Depression (not FDA approved)
Early trials indicate that Botox can help people with depression, even though many experts remain skeptical. The proposed mechanism is based on the facial feedback hypothesis, which states that a person’s facial expressions can impact their mood. According to a 2014 study of 74 people with major depressive disorder, 52 percent of those who received Botox experienced a reduction in symptoms six weeks later, compared to 15% of those who received a placebo. Clinical trials are currently underway to determine whether Botox can be used to treat depression.
Heartbeat Irregularity (not FDA approved)
Botox is being studied as a possible treatment for abnormal heartbeat patterns following open-heart surgery (called postoperative atrial fibrillation). Researchers decided to take a drug that had been on the market for 27 years and had a good understanding of its safety profile to a significant unmet need.
Severe Cold hands(not FDA approved)
At a particular University in Chicago, doctors use Botox off-label to treat patients with freezing hands. Botox is injected into a person’s hand to relax the muscles surrounding constricted blood vessels, thereby improving circulation. Blood flows through the hand when the vessels relax and enlarge, bringing relief to the symptoms. The treatment, according to doctors, could last three months.
Scars on the cleft lip (not FDA approved)
Approximately 2,650 babies are born with cleft palates every year, and 4,440 babies are born with cleft lips. A large number of people require surgery. Some doctors inject Botox into infants’ scars to keep the muscles from contracting and allowing the wounds to heal. The wounds will look much better as a result. Botox is being administered to infants, but there is science behind it, and it is a relatively new and innovative treatment option.
Painful sex (not FDA approved)
Muscle spasms or vaginal contractions can make sex painful for some women. By preventing muscles from contracting, Botox injections can help to relieve pain. According to doctors who provide Botox injections for painful sex, some women may require injections every six months, while others may only require injections every few years.
Severe neck spasms (FDA approved)
Botox was first approved in 2000 to treat cervical dystonia, a disorder characterized by abnormal head position and severe neck pain before it was approved for frown lines between the brows in 2002.