Questioning Botulinum Toxin for Headache

Headache Direction and Aura Predict Migraine Responsiveness to Rimabotulinumtoxin B

“…Beyond BT's action on extracranial nociceptors, it remains arguable that BT “lacks a logical” or “reasonable” fundamental pathophysiologic mechanism for how it modulates pain . Numerous articles, in fact, have been published to provide a plausible explanation of the pain‐modulating properties of BTs.…”

“…Beyond BT's action on extracranial nociceptors, it remains arguable that BT "lacks a logical" or "reasonable" fundamental pathophysiologic mechanism for how it modulates pain. 26,27 Numerous articles, in fact, have been published to provide a plausible explanation of the pain-modulating properties of BTs. Nociceptive transmission is dependent on specific neurotransmitters and is "well suited to inhibition by therapies affecting vesicular release of these."…”

Headache Direction and Aura Predict Migraine Responsiveness to Rimabotulinumtoxin B

“…Beyond BT's action on extracranial nociceptors, it remains arguable that BT “lacks a logical” or “reasonable” fundamental pathophysiologic mechanism for how it modulates pain . Numerous articles, in fact, have been published to provide a plausible explanation of the pain‐modulating properties of BTs.…”

“…Beyond BT's action on extracranial nociceptors, it remains arguable that BT "lacks a logical" or "reasonable" fundamental pathophysiologic mechanism for how it modulates pain. 26,27 Numerous articles, in fact, have been published to provide a plausible explanation of the pain-modulating properties of BTs. Nociceptive transmission is dependent on specific neurotransmitters and is "well suited to inhibition by therapies affecting vesicular release of these."…”

Botulinum toxin A injection into corrugator muscle for frontally localised chronic daily headache or chronic tension-type headache

“…Our study was not a double-blind trial, so the effect of botulinum toxin treatment may have been influenced by many biases. However, the effect of botulinum toxin A on nearby skin wrinkles makes it impossible to conduct a truly blinded study 15 . A high placebo response is an established confounder in evaluating the treatment of painful conditions 6 , 21 .…”

“…The literature includes some placebo-controlled, double-blind trials conducted to evaluate the effectiveness of headache treatment with botulinum toxin A. Most authors conclude that botulinum toxin A is not highly effective, or not effective at all 2 , 15 . However, these trials mix headache types and/or injection sites and doses 3 , 4 , 6 , 7 , 23 .…”

“…Furthermore, these studies do not mention the corrugator supercilii muscle as a specific site. Most importantly, there is no convincing rationale for this therapy 15 . Some authors do consider the effects of botulinum toxin A injection into the corrugator muscle and of resection of this muscle, but mainly for the treatment of migraine 16 , 17 , 18 , 20 , 24 , 25 …”

Headache Direction and Aura Predict Migraine Responsiveness to Rimabotulinumtoxin B

“…Beyond BT's action on extracranial nociceptors, it remains arguable that BT “lacks a logical” or “reasonable” fundamental pathophysiologic mechanism for how it modulates pain . Numerous articles, in fact, have been published to provide a plausible explanation of the pain‐modulating properties of BTs.…”

“…Beyond BT's action on extracranial nociceptors, it remains arguable that BT "lacks a logical" or "reasonable" fundamental pathophysiologic mechanism for how it modulates pain. 26,27 Numerous articles, in fact, have been published to provide a plausible explanation of the pain-modulating properties of BTs. Nociceptive transmission is dependent on specific neurotransmitters and is "well suited to inhibition by therapies affecting vesicular release of these."…”

Botulinum toxin A injection into corrugator muscle for frontally localised chronic daily headache or chronic tension-type headache

“…Our study was not a double-blind trial, so the effect of botulinum toxin treatment may have been influenced by many biases. However, the effect of botulinum toxin A on nearby skin wrinkles makes it impossible to conduct a truly blinded study 15 . A high placebo response is an established confounder in evaluating the treatment of painful conditions 6 , 21 .…”

“…The literature includes some placebo-controlled, double-blind trials conducted to evaluate the effectiveness of headache treatment with botulinum toxin A. Most authors conclude that botulinum toxin A is not highly effective, or not effective at all 2 , 15 . However, these trials mix headache types and/or injection sites and doses 3 , 4 , 6 , 7 , 23 .…”

“…Furthermore, these studies do not mention the corrugator supercilii muscle as a specific site. Most importantly, there is no convincing rationale for this therapy 15 . Some authors do consider the effects of botulinum toxin A injection into the corrugator muscle and of resection of this muscle, but mainly for the treatment of migraine 16 , 17 , 18 , 20 , 24 , 25 …”

Headache Direction and Aura Predict Migraine Responsiveness to Rimabotulinumtoxin B

“…Beyond BT's action on extracranial nociceptors, it remains arguable that BT “lacks a logical” or “reasonable” fundamental pathophysiologic mechanism for how it modulates pain . Numerous articles, in fact, have been published to provide a plausible explanation of the pain‐modulating properties of BTs.…”

“…Beyond BT's action on extracranial nociceptors, it remains arguable that BT "lacks a logical" or "reasonable" fundamental pathophysiologic mechanism for how it modulates pain. 26,27 Numerous articles, in fact, have been published to provide a plausible explanation of the pain-modulating properties of BTs. Nociceptive transmission is dependent on specific neurotransmitters and is "well suited to inhibition by therapies affecting vesicular release of these."…”

Botulinum toxin A injection into corrugator muscle for frontally localised chronic daily headache or chronic tension-type headache

“…Our study was not a double-blind trial, so the effect of botulinum toxin treatment may have been influenced by many biases. However, the effect of botulinum toxin A on nearby skin wrinkles makes it impossible to conduct a truly blinded study 15 . A high placebo response is an established confounder in evaluating the treatment of painful conditions 6 , 21 .…”

“…The literature includes some placebo-controlled, double-blind trials conducted to evaluate the effectiveness of headache treatment with botulinum toxin A. Most authors conclude that botulinum toxin A is not highly effective, or not effective at all 2 , 15 . However, these trials mix headache types and/or injection sites and doses 3 , 4 , 6 , 7 , 23 .…”

“…Furthermore, these studies do not mention the corrugator supercilii muscle as a specific site. Most importantly, there is no convincing rationale for this therapy 15 . Some authors do consider the effects of botulinum toxin A injection into the corrugator muscle and of resection of this muscle, but mainly for the treatment of migraine 16 , 17 , 18 , 20 , 24 , 25 …”