Botulinum toxin type A in refractory chronic migraine: an open-label trial

Menezes, Carla; Rodrigues, Bernardo; Magalhães, Elza; Melo, Aílton

doi:10.1590/s0004-282x2007000400009

Cited by 11 publications

(7 citation statements)

References 17 publications

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“…These included hematoma at the site of injection, blepharoptosis and local pain at the site of injection. These results were previously recognized in various reports that confirmed the safety and tolerability of BTX-A in headache patients [22, 26–28, 36, 39–42, 46]. …”

Section: Discussionsupporting

confidence: 78%

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Botulinum toxin: could it be an effective treatment for chronic tension-type headache?

et al. 2008

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Several clinical trials suggest that botulinum toxin type-A (BTX-A) may be an effective treatment option for patients with chronic tension-type headache (CTTH); however, controversy remains as to how the botulinum toxin optimally should be used for treating headache and which patient's profile fits this treatment. The objective of this study was to evaluate the efficacy and tolerability of BTX-A for the prophylactic treatment of CCTH in Egyptian patients. This was a randomized, single-blind, placebo-controlled study of BTX-A for the treatment of patients aged 25–50 years old with CCTH. Following a 30-day screening, headache parameters and severity assessed by the standard visual analogue scale (VAS), and the 25-item Henry Ford Hospital Headache Disability Inventory (HDI) were recorded as a baseline. Then, injection was done with either BTX-A or with saline by a combination of two methods for detecting injection sites (the fixed-site approach and follow-the-pain approach). Our study showed significant improvement after 1 month of BTX-A injection regarding headache days/month, severity measured by VAS and HDI in headache severity. There was significant reduction of prophylactic medications, and there were minor complications, but these reversed spontaneously without further treatment. BTX-A was an effective and well-tolerated prophylactic treatment in Egyptian patients with CCTH.

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Section: Discussionsupporting

confidence: 78%

“…It seems clear that there is no standardized points for injections in headache patients, and the selected protocol for injections and injection application techniques sometimes are regarded as important causes of lack of efficacy of BT-A, and a larger distribution of injection points seems compatible with better results [36]. …”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin: could it be an effective treatment for chronic tension-type headache?

et al. 2008

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“…In the pivotal studies, 0/406 migraine patients (0 %) developed neutralizing antibodies following treatment with onabotulinumtoxinA after 24 weeks (two treatment cycles) (BOTOX® [package insert] 2011). Antigenicity rates were not reported in a small, open-label trial of abobotulinumtoxinA for the treatment of chronic migraine (Menezes et al 2007), and neither incobotulinumtoxinA nor rimabotulinumtoxinB have been studied for this indication.…”

Section: Chronic Migrainementioning

confidence: 99%

Immunogenicity of botulinum toxins

et al. 2012

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Botulinum neurotoxins are formulated biologic pharmaceuticals used therapeutically to treat a wide variety of chronic conditions, with varying governmental approvals by country. Some of these disorders include cervical dystonia, post-stroke spasticity, blepharospasm, migraine, and hyperhidrosis. Botulinum neurotoxins also have varying governmental approvals for cosmetic applications. As botulinum neurotoxin therapy is often continued over many years, some patients may develop detectable antibodies that may or may not affect their biological activity. Although botulinum neurotoxins are considered “lower risk” biologics since antibodies that may develop are not likely to cross react with endogenous proteins, it is possible that patients may lose their therapeutic response. Various factors impact the immunogenicity of botulinum neurotoxins, including product-related factors such as the manufacturing process, the antigenic protein load, and the presence of accessory proteins, as well as treatment-related factors such as the overall toxin dose, booster injections, and prior vaccination or exposure. Detection of antibodies by laboratory tests does not necessarily predict the clinical success or failure of treatment. Overall, botulinum neurotoxin type A products exhibit low clinically detectable levels of antibodies when compared with other approved biologic products. This review provides an overview of all current botulinum neurotoxin products available commercially, with respect to the development of neutralizing antibodies and clinical response.

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“…However, results obtained in studies of BoNT treatment for patients with CTTH have not been uniformly positive. There are noticeable variations in the results obtained by random-sampling studies, especially arising from differences in BoNT dosages and the lack of standardization of injection sites (Ates, 2006;Hamdy et al, 2009;Menezes, Rodrigues, Magalhaes, & Melo, 2007;Rozen & Sharma, 2006). This situation indicates the need to clearly identify the most-appropriate injection sites when administering BoNT to treat headaches.…”

Section: Introductionmentioning

confidence: 99%

Intramuscular innervation patterns of the splenius capitis and splenius cervicis and their clinical implications for botulinum toxin injections

2020

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Introduction: The purpose of this study was to clearly characterize the intramuscular nerve distributions of the splenius capitis and splenius cervicis muscles that are both responsible for the onset of a chronic tension type headache and to use this information to identify the effective botulinum toxin (BoNT) injection sites. Materials and Methods: Ten splenius capitis and splenius cervicis specimens were subjected to Sihler's staining to reveal intramuscular nerve arborization patterns and determined the optimal location for BoNT injection. Results: Nerve distribution patterns in the splenius capitis were identified as nerve pathways that travel down toward the origin point and others that travel up toward the insertion point. This neuromuscular innervation from the central (50%) point was distributed evenly in these two directions. The neural pathways of splenius cervicis traveled vertically from the insertion point to the origin point. If the length from the muscle origin point to the insertion point is normalized to 100%, motor neurons innervate the muscle from around the 30% to the 70% point. Conclusions: The safest and most-effective BoNT injection sites for the splenius capitis and splenius cervicis were found at around the 50% point and the 30% to the 70% point, respectively.

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Botulinum toxin type A in refractory chronic migraine: an open-label trial

Cited by 11 publications

References 17 publications

Botulinum toxin: could it be an effective treatment for chronic tension-type headache?

Botulinum toxin: could it be an effective treatment for chronic tension-type headache?

Immunogenicity of botulinum toxins

Intramuscular innervation patterns of the splenius capitis and splenius cervicis and their clinical implications for botulinum toxin injections

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