The Use of Botulinum Toxins in the Management of Pain and Headache

Treatment Algorithm Overview: BoNT Therapy for Pain

“…Because neither product nor diluent contains any preservative, Botox should be administered within 4 hours of reconstitution. The tered with Botox and Myobloc, including: (1) localized pain, tenderness, and bruising at the injection site; (2) weakness of adjacent musculature through neurotoxin diffusion; (3) dysphagia and associated upper respiratory infection; and (4) in the case of Myobloc, an increased tendency for remote effects such as hemifacial ptosis due to enhanced systemic diffusion. Although adverse reactions are usually seen during the first week following injection and are generally transient, it is possible that some may persist for several weeks.…”

“…In addition, BoNT/A should not be administered more frequently than every 3 months. 2 Until additional clinical data are obtained with BoNT/B, initial therapy should be approached cautiously, with a maximum dose of 2500 to 5000 units. 2…”

Botulinum Neurotoxin in Chronic Pain Management

“…3 Other studies of BoNT/A for headache pain also yielded positive results. [11][12][13][14][15] Additionally, in one study, the use of acute conventional migraine treatments (NSAIDs and triptans) was significantly reduced. 15 Both patient and investigator global effectiveness evaluations also showed a marked improvement for the majority of BoNT/A patients.…”

The Use of Botulinum Toxin in the Treatment of Headaches

“…In contrast, BTX-A is simple to administer, has few systemic effects, and the beneficial effects of a single dose may last for 3 months. In their summary of the numerous clinical uses for which BTX-A has been reported, Royal et al (60) noted that major benefit of BTX-A may be its duration of efficacy. Nonetheless, BTX-A was not recommended for first-line use.…”