Effect of Botulinum Toxin A Injections in the Treatment of Chronic Tension‐type Headache: A Double‐Blind, Placebo‐Controlled Trial

Abstract

In addition to vascular and supraspinal influences, contraction of craniofacial muscles or central sensitization processes following continuous nociceptive input of craniofacial muscles may play an important role in the pathogenesis of tension-type headache. Chemodenervation induced by botulinum toxin injection is successfully used to decrease muscle tension. If muscle tension is important in this type of headache, then botulinum toxin could be helpful in its treatment. We conducted a randomized, placebo-controlled study to examine the effect of 20 U botulinum toxin injected into frontal and temporal muscles in patients with chronic tension-type headache. During a baseline of 4 weeks and a posttreatment period of 8 weeks, the effect was evaluated with daily records and the West Haven-Yale Multidimensional Pain Inventory. Some improvement in affective variables were demonstrated in the botulinum group, but important outcome variables, such as pain intensity, the number of pain-free days, and consumption of analgesics, were not statistically different between the groups. Reasons for these moderate effects may include the injection sites, dose of botulinum toxin, and duration of treatment.

Long-term benefits of botulinum toxin type A (BOTOX) in chronic daily headache: a five-year long experience

“…A long list of studies, which cannot be discussed here, represent "pro" and "cons" factions [29][30][31][32][33][34][35][36][37][38][39][40].…”

An open label, randomised, pilot study of botulinum toxin type-A in the treatment of chronic tension-type headache

“…With respect to CTTH, Schmitt et al [13] performed a double-blind, placebo-controlled, randomised study in which BTX-A injections conferred a slight benefit to patients with CTTH for affective variables at the first month as determined by the West Haven-Yale multidimensional pain inventory (WHYMPI). However, pain reduction, analgesia intake and activity level did not differ between BTX-A and control groups.…”

“…In addition, this study demonstrated a significant placebo response, which may suggest psychological factors could play a role in this condition. Schmitt et al suggest individualised patient therapeutic regimens with repeated injections may provide most benefit [13].…”

Pain and tension-type headache: a review of the possible pathophysiological mechanisms

“…Studies of the therapeutic effect of pericranial botulinum toxin type A injections, which reduce muscle tone, yielded different results [28]. Schmitt et al [29] demonstrated some improvement in affective variables, but the pain intensity, the number of pain-free days, and the consumption of analgesics, were not statistically different between the groups of patients who received botulinum toxin and placebo. Rollnik et al [30,31] did not find any beneficial effect of botulinum toxin compared with placebo despite some objectively recorded reduction in resting muscle activity.…”