The use of botulinum toxin type A in headache treatment

The number of migraine treatments and our understanding of migraine pathophysiology are both increasing. Newer treatments focus on migraine prevention. Botulinum toxin (BTX) is a potent neurotoxin used primarily to treat diseases associated with increased muscle activity. Recently, BTX was found to have antinociceptive effects that are probably independent of its muscle-relaxant action. Clinical trials support the efficacy of BTX type A (and possibly also type B) in the treatment of migraine. The anticonvulsant topiramate was recently shown to be effective for migraine prevention. At the low doses used for this indication, cognitive side effects are not a major concern. Another new approach to migraine prevention is angiotensin type 1 (AT1) receptor blockade. The high tolerability of the AT1 receptor blocker candesartan warrants further studies to assess its role in migraine prevention.

show abstract

“…Its use in migraine and other types of chronic headaches was recently studied and showed positive results (29,(46)(47)(48)(49) …”

Section: Clinical Uses -General (Second Heading)mentioning

confidence: 99%

Botulinum Toxin and Other New Approaches to Migraine Therapy

Ashkenazi

Silberstein

2004

Annu. Rev. Med.

View full text Add to dashboard Cite

show abstract

“…However, in the search for a well-tolerated treatment, BTX-A is emerging as a promising agent for treatment of headache in patients where the condition is poorly controlled [7].…”

Section: Discussionmentioning

confidence: 99%

“…A number of double-blind and open-label trials have been performed in both migraine and CTTH, many of which demonstrate that BTX-A reduces the frequency and severity of headaches, improves disability scales, improves quality of life and reduces analgesia use [7,9]. In addition, cost benefits have been shown following BTX-A use, with significant reductions in both analgesic use and expenditure [10].…”

Section: Discussionmentioning

confidence: 99%

“…This may be due to its inhibition of substance P release and reduction in release of nociceptive neuropeptides from either cholinergic neurons or from C or A delta fibres, preventing local sensitisation of nociceptors and reducing pain sensation. As such, some investigators have suggested that it may have a role in relieving chronic pain associated with TTH [7]. Indeed, early cosmetic use of BTX and some case studies have found alleviation of tension headaches, as well as improvement in migraine headaches, although a clear scientific basis for this finding has yet to be established [8].…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Porta

Maggioni

2004

J Headache Pain

View full text Add to dashboard Cite

The objective was to assess the effect of botulinum toxin type-A (BTX-A) in treating chronic tension-type headache (CTTH). A single centre, open label, pilot study was carried out at the Headache and Pain Center, Neurology Department, Policlinico San Marco, Bergamo, Italy and the Istituto Ortopedico Galeazzi, Milan, Italy. Sixty consecutive patients meeting accepted criteria for CTTH were randomised into 3 equal groups. Group 1: patients injected in fixed points; Group 2: patients injected using the “follow the pain” approach; and Group 3: as per Group 2 but combined with physiotherapy. Patients were assessed for 4 months using a headache diary, and efficacy was evaluated using a verbal rating scale (VRS), changes in headache frequency and drug intake count. At month 3, all groups showed improvements in VRS, mean headache frequency and mean drug intake, with Group 3 showing the greatest improvements in VRS and drug intake. BTX-A may be a promising therapy for treatment of CTTH using the “follow the pain” approach, especially when combined with adjunctive physiotherapy.

show abstract

“…Within the CDH population, Silberstein et al [26] noted that roughly 78% have chronic migraine, 15% have CTTH, and 7% have other chronic headache disorders. Almost 5% of the general population (9% of women) suffer from CDH, and some 80% of these overuse symptomatic medications [27]. My personal experience, discussed later, and that of others [23] suggests that BoNT-A may be one of the most effective therapies for chronic daily headache, along with analgesic reduction.…”

Section: Chronic Daily Headachementioning

confidence: 96%

Botulinum toxin type A in the management of headache: a review of the literature and personal experience

Troost

2004

J Headache Pain

View full text Add to dashboard Cite

IntroductionBotulinum toxin type A (BoNT-A) shows significant promise in the management of a variety of headache types. Pivotal double-blind placebo-controlled trials are currently underway to establish potential efficacy in the management of headache. This review covers recent literature and personal experience in the management of headaches with BoNT-A.Headache is one of the most common neurological symptoms in clinical practice. It is estimated that approximately 18% of women and 6% of men suffer from migraine, with the disorder affecting roughly 28 million Americans [1]. The lifetime prevalence of headache approaches 99% in women and 93% in men [2].Headache disorders constitute a significant publichealth problem with an impact on both the individual sufferer and society. Lipton and Stewart [3] estimated that lost productivity associated with migraine cost the US economy between $1 billion and $17 billion. A pharmacoeconomic survey in the United States by Hu et al. [4] found that migraine sufferers required a total of 112 million days of bed rest costing employers about $13 billion per year because of missed workdays and impaired function.Patients with headache unresponsive to acute medications suffer considerable disability due to the frequency and severity of attacks and should be considered for preventive therapy [5]. Current preventive treatments tend to have a modest effect along with a substantial side effect burden related to vascular or systemic distribution [5]. Loder and Biondi [6], in an excellent review of the use of botulinum toxins for chronic headache, described previous reports of the use of botulinum toxin for migraine, chronic daily headache, tension-type headache, and other headache types, concluding that the use of botulinum toxin is of great interest and "deserves accelerated study."In the sections that follow, studies are reported in various categories, but many of them deal with different B. Todd TroostAbstract Botulinum toxin type A (BoNT-A) shows significant promise in the management of a variety of headache types including migraine, chronic daily headache, tension-type headache, and other head and neck pains. Confirmation of efficacy still awaits the report of well-controlled double-blind placebo-controlled trials; however, a mounting body of evidence suggests that BoNT-A is effective, well-tolerated and safe for the management of many headache disorders. In this paper, I review recent evidence on the efficacy of BoNT-A, and also report my personal experience with the treatment in over 600 headache patients.

show abstract

The use of botulinum toxin type A in headache treatment

Cited by 34 publications

References 31 publications

Botulinum Toxin and Other New Approaches to Migraine Therapy

Botulinum Toxin and Other New Approaches to Migraine Therapy

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

Botulinum toxin type A in the management of headache: a review of the literature and personal experience

Contact Info

Product

Resources

About