Botulinum toxin type A in the treatment of chronic migraine and chronic tension-type headache

Abstract

Background: The analgesic effect of botulinum toxin type A (BoNT/A) has been discussed in the treatment of various painful conditions. BoNT/A efficacy has not been proven in tension type headache, its use in migraine and chronic daily headaches remains controversial. Goal: In this open trial we evaluated the efficacy of BoNT/A in chronic migraine (CM) and chronic tension-type headache (CTTH). Material and methods: 30 patients with CM and 30 patients with CTTH were injected with BoNT/A (at an average dose of 100 Botox® U) into the procerus, corrugator, frontalis, temporalis and occipitalis muscles. Clinical evaluation was performed at baseline and after 12 weeks of treatment. Data were obtained from headache diaries. Results: Treatment with BoNT/A led to reduction of both number of headache days per month (from 24.6 to 16.0) and number of analgesic tablets per month (from 21.9 to 12.8) in patients with CM. Number of responders was 41% in 12 weeks after injections of BoNT/A. In patients with CTTH results of treatment with BoNT/A were found worse. Number of responders reached only 24%. The BoNT/A treatment was safe and well-tolerated, since only 3.6% of patients reported mild and transient adverse events. Conclusion: Significant beneficial effect of BoNT/A was clearly demonstrated in the treatment of CM, but not in CTTH. For further results optimal patient population and regimen have to be definitively established.