Treatment with botulinum toxin: An update

Botulinum Neurotoxin a for Chronic Migraine Headaches: Does it Work and How?

“…However, patients who received BoNTA had more adverse events than had been previously recognized and a large placebo effect was identified. Thus, while BoNTA appears to be effective for chronic migraine and chronic daily headache, more evidence-based data is needed to provide reliable information for or against the use of BoNTA in other types of headaches, which include cervicogenic or cluster headaches [5]. The findings of these studies provide insight into which headache types might respond to BoNTA, but definitive predictors of individual patient response have not yet been identified.…”

“…Migraine aura might also be a predictor of response. While it is clear that additional work is needed to improve identification of best candidates for, and optimal route, location and dose of administration of BoNTA [7], there is general agreement that both fixed-site/fixed-dose and 'follow-the-pain' paradigms are effective for headache prophylaxis [5]. Future clinical trials may also reveal whether other botulinum neurotoxins (e.g., BoNTB) have comparable safety and efficacy profiles to BoNTA.…”

Botulinum Toxin in Pediatric Neurology

“… 22 In 1998, BoNT-A became licensed for use in children over the age of 2 years for management of dynamic equinus foot deformity in ambulant children with CP. This remains the only Food and Drug Administration (FDA)–approved indication; however, many studies have supported the efficacy of BoNT-A 23 , 24 as the first-line treatment for focal or multifocal spasticity. The BoNT treatment modality is usually carried out as an adjunct to other rehabilitative strategies, which are based on individualized, multidisciplinary programs that are targeted to achieve patient goals.…”

“…Thus, BoNT therapy for treating essential tremor should be considered only in medically refractory cases. 24 …”

“…Several strategies of injection (fixed or “follow the pain”) using a wide range of doses have been suggested for different forms of headache without conclusive results. 24 One controlled trial has shown the efficacy of the BoNT therapy in headache. 98 In this study, which was designed for the prophylactic treatment of chronic migraine, patients received 155 units of BoNT-A every 12 weeks administered to 31 injection sites across 7 specific head and neck muscle areas using a fixed-site, fixed-dose injection paradigm.…”