(790): Botulinum toxins in the treatment of occipital neuralgia

Abstract

Myobloc® (Botulinum toxin type B) is FDA-approved for the treatment of cervical dystonia(CD). However, Myobloc has also demonstrated utility in treating a number of chronic pain conditions, including myofascial and low back pain, headache and neuropathic pain. The following case reports represent its use in the treatment of occipital neuralgia. GN was a 43 year-old right-handed female with a nine-year history of daily headaches localized to the forehead and occipital area. Initial neurological exam showed spasms tenderness over the occipitocervical junctions. MRI of the brain with and without contrast was normal. Numerous medications including nortriptyline, gabapentin, topiramate, levatiracetam, nadolol, phenobarbital, tramadol were ineffective or not tolerated. She had word-finding difficulty with topiramate. A series or three bilateral occipital nerve blocks (combination of local anesthetic and steroid) provided complete headache relief for two weeks each. Myobloc (5000 units) was added to local anesthetic and provided headache relief for greater than 2 months. PG was a 53 year-old female with right occipital neuralgia. She failed oral agents and was treated with BT-A 100 units and local anesthetic, which produced 6 weeks of pain relief with an onset 2 weeks after injection. Her next injection with Myobloc 5000 units (combined with local anesthetic) produced an increased duration of pain relief of 3 months. TW was a 55 year-old man with occipital neuralgia. His pain was intractable to oral agents and was injected with Myobloc 5000 units mixed with local anesthetic. His pain relief has lasted beyond 1.5 months. These 3 case reports demonstrate the potential use of BTs in treating occipital neuralgia. Additional clinical trials are warranted.