Botulinum toxin type-A therapy in cluster headache: an open study

Sostak, P.; Krause, Phillip; Förderreuther, Stefanie; Reinisch, Veronika M.; Straube, Andreas

doi:10.1007/s10194-007-0400-0

Cited by 55 publications

(30 citation statements)

References 34 publications

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“…is not enough to establish firm evidence." 27 Others had tried unsuccessfully to use BT in trigeminal neuralgia, [28][29][30][31][32][33][34][35][36][37][38][39] occipital neuralgia, 35,40,41 and, to date, no RCTs have ever been performed in cluster headache, [42][43][44][45] other trigeminal autonomic cephalalgias, or hemicrania continua. 15,46 Secondary headaches were never systematically studied, and even treating cervicogenic headache with BT yielded no firm evidence favoring its use.…”

Section: Bt In the Treatment Of Head And Face Painmentioning

confidence: 99%

Botulinum Toxin and the Treatment of Headache: A Clinical Review

Finkel

2011

Headache: The Journal of Head and Face Pain

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Parsing head pain is about classifying the common complaints people bring to us. Classification of primary headaches implies a discoverable pathology. It is assumed that by creating procedures or drugs which correct that pathology, we can provide new ways of treating the common headache disorders. The recent approval of onabotulinum toxin A (OBA) for the treatment of chronic migraine (CM) may offer just such an opportunity. Yet by attempting to answer old questions, new ones have been raised amongst by this new treatment, some of which include:Is the effectiveness of botulinum toxin (BT) in CM based upon its analgesic properties or does it have something to do with the action of the toxin on the pathology underlying CM?Is it going to prove to be an effective tool for those patients who might need it most? BT IN THE TREATMENT OF HEAD AND FACE PAINIn 1989, the orphan drug botulinum toxin batch 79-11 ("Oculinum") was approved by the Food and Drug Administration for the treatment of blepharospasm. 1 Within 5 years, the first paper appeared on the use of BT in headache. 2 In the years since, we have seen an incremental increase in publications and clinical trials, but as shown in the Figure, the number of publications of new randomized controlled trials (RCTs) since 2004 has been stable. 3 Many of the other publications and reviews cited the same datasets.From its first use, BT was used for the treatment of headache, temporomandibular dysfunction (TMD), myofascial face pain, and bruxism. 4-18 At that time, treating myofascial pain with injections was common and clinically driven by such authors as Janet Travell and David Simons whose Myofascial Pain and Dysfunction: The Trigger Point Manual was a mainstay of pain treatment. Their work was based upon the belief that pain could be reproduced with touch and that following pain with injections could lead to relief at some distance from the trigger point. 19 The evidence for treating myofascial pain of and outside of the face with BT was not forthcoming, 20-22 although correlating pain relief with weakening muscles with a presumed reduction in spasm may have found some credence in the treatment of TMD. 23-26 One author concluded that BT "appears both safe and efficacious in . . . chronic facial pain associated with masticatory hyperactivity," although he cautioned that one "RCT . . . is not enough to establish firm evidence." 27 Others had tried unsuccessfully to use BT in trigeminal neuralgia, 28-39 occipital neuralgia, 35,40,41 and, to date, no RCTs have ever been performed in cluster headache, 42-45 other trigeminal autonomic cephalalgias, or hemicrania continua. 15,46 Secondary headaches were never systematically studied, and even treating cervicogenic headache with BT yielded no firm evidence favoring its use. 47-49 Also, the well-established treatment of pain associated with cervical dystonia 50 did not translate to a treatment for headache associated with cervical dystonia. 15,[51][52][53][54][55] In their comprehensive review of pain treatment with BT, Rawicki et a...

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Section: Bt In the Treatment Of Head And Face Painmentioning

confidence: 99%

Botulinum Toxin and the Treatment of Headache: A Clinical Review

Finkel

2011

Headache: The Journal of Head and Face Pain

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“…1A), which have been mostly selected to treat migraine with BTX-A in previous studies (10, 11, 15) (30, 31). The injection sites in group A were respectively at EX-HN3 (Yintang), EX-HN5 (Taiyang), GV20 (Baihui), GB8 (Shuaigu), GB20 (Fengchi) and BL10 (Tianzhu), based on predetermined and well-known Chinese acupoints for the treatment of migraine (Figure.…”

Section: Methodsmentioning

confidence: 99%

Botulinum Toxin Type A Therapy in Migraine: Preclinical and Clinical Trials

Shao¹,

Zhang²,

Zhao³

et al. 2013

Iran Red Crescent Med J

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BackgroundBotulinum toxin type A (BTX-A) has been reported to be effective for the therapy for migraine. The purpose of this study was to investigate the effect of BTX-A on the immunoreactive levels of calcitonin gene-related peptide (CGRP) and substance P (SP) in the jugular plasma and medulla oblongata of migraine in rats induced by nitroglycerin (NTG), and then to evaluate and compare the effectiveness of fixed (muscle)-sites and acupoint-sites injection of BTX-A for migraine therapy of patients in a randomly controlled trial extending over four months.Materials and MethodsRats with NTG-induced migraine were subcutaneously injected with vehicle or BTX-A (5 U/kg or 10 U/kg bodyweight). CGRP- and SP-like immunoreactivity (CGRP-LI and SP-LI) were determined by radioimmunoassay. In clinical trials, sixty patients respectively received BTX-A (2.5 U each site, 25 U per patient) at fixed-sites (group F, n = 30) including occipitofrontalis, corrugator supercili, temporalis and trapezius or at acupoint-sites (group A, n = 30) including EX-HN3, EX-HN5, GV20, GB8, GB20 and BL10.ResultsLocal BTX-A injection suppressed NTG-induced CGRP-LI and SP-LI levels in jugular plasma and oblongata. BTX-A injection for both groups with migraine significantly reduced the attack frequency, intensity, duration and associated symptoms. The efficacy of BTX-A for migraine in group A (93% improvement) was more significant than that in group F (83% improvement) (P < 0.01).ConclusionsThe evidence that BTX-A decreases NTG-induced CGRP-LI and SP-LI levels in trigeminovascular system suggests that BTX-A attenuates migraine by suppression of neuropeptide release. BTX-A injections for migraine at acupoint-sites and fixed-sites are effective. Acupoint-sites BTX-A administration shows more efficacy for migraine than fixed-sites application.

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“…Vier der Patienten mit chronischem Clusterkopfschmerz sprachen auf die Behandlung bei guter Verträglichkeit an (1-mal Attackenfreiheit, 2-mal Attackenreduktion, 1-mal Reduktion eines zusätzlichen Dauerkopfschmerzes; [38]). Eine aktuelle Studie untersuchte nun in einem offenen Design die technisch aufwendige Injektion von 25 und 50 Einheiten Botulinumtoxin ins Ganglion sphenopalatinum beim therapierefraktären Clusterkopfschmerz.…”

Section: Trigeminoautonome Kopfschmerzerkrankungenunclassified

Botulinumtoxin A in der Kopfschmerztherapie

2016

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In recent years botulinum toxin type A has been used increasingly more in the treatment of specific headache disorders. Especially regarding chronic migraine with and without combined medication overuse, convincing randomized studies have proven the efficacy of this treatment option and have led to approval for this indication. Regarding other headache entities, such as episodic migraine, tension-type headache, trigeminal autonomic cephalalgia (TAC), neuralgic, neuropathic and myofascial pain, currently available scientific data on the efficacy of botulinum toxin type A are scarce and often ambiguous. The exact underlying mechanisms of the influence of botulinum toxin type A on the pathophysiology of headache are not completely clear but an influence on the release of calcitonin gene-related peptide (CGRP) seems to play a crucial role. This article summarizes the most important studies as well as experiences of treatment with botulinum toxin type A regarding different headache entities.

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Botulinum toxin type-A therapy in cluster headache: an open study

Cited by 55 publications

References 34 publications

Botulinum Toxin and the Treatment of Headache: A Clinical Review

Botulinum Toxin and the Treatment of Headache: A Clinical Review

Botulinum Toxin Type A Therapy in Migraine: Preclinical and Clinical Trials

Botulinumtoxin A in der Kopfschmerztherapie

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