Onabotulinum toxin A treatment of cervicogenic headache: A randomised, double-blind, placebo-controlled crossover study

Abstract

Onabotulinum toxin A in neck muscles does not seem to be beneficial in CeH.

Botulinum neurotoxin type-A when utilized in animals with trigeminal sensitization induced a antinociceptive effect

“…Muscle weakness appeared in only 3.9% of the patients 13 . In episodic migraine patients treated with BoNT/A, neck pain occurred in 17.1% of the treated group versus 4.4% of the placebo group, a statistically significant difference 29 . One of the main differences between chronic migraine and episodic migraine is sensitization.…”

“…One of the main differences between chronic migraine and episodic migraine is sensitization. The results of the literature clearly demonstrate that in subjects with headache lacking sensitization (episodic migraine) the side effect of BoNT/A was greater than patients with sensitization (chronic migraine) (17,1% versus 4,6% respectively) 13,29 . In cervicogenic headache, pain worsening occurred in 30% of patients treated with BoNT/A and 17% of those treated with placebo 30 .…”

Botulinumtoxin A in der Kopfschmerztherapie

“…In einem doppelblinden placebokontrollierten Crossover-Design wurde die Wirkung von 100 Einheiten BotulinumtoxinbeiPatientenmitbis dahintherapierefraktären zervikogenen Kopfschmerzen untersucht [27]. Zielpunkte der Botulinumtoxininjektionen waren die okzipitale Muskulatur und die Mm.…”

Cervicogenic headache and onabotulinumtoxinA: Where do we stand?

“…The recent PREEMPT trials that finally supported efficacy for OBTA in chronic migraine randomized a total of 688 patients to OBTA treatment and 696 to placebo (2,3). In addition, the study by Linde et al (1) can be criticized in that subjects could be crossed over to the other treatment arm in as little as 8 weeks after initiation of treatment. What this means is that patients who received OBTA in the initial part of the study could be crossed over to placebo after 8 weeks, even though it is generally recognized that the effects of OBTA can last as long as three months.…”

“…In short, Linde et al (1) have made an important contribution to the field, but given the complexity of cervicogenic headache and the uncertainty around the mechanisms whereby OBTA exerts its anti-nociceptive effects, it is probably premature to conclude that OBTA does not have the potential to be of value in at least a subgroup of patients with cervicogenic headache. On the other hand, the study certainly provides no evidence for benefit.…”