Management of Chronic Daily Headache with Focus on Botulinum Toxin Type A

Kadyrkhodjayeva N,Prokhorova A

doi:10.36502/2020/hcr.6159

Abstract

Aim: The purpose of the study was to review the efficacy, safety, and tolerability of botulinum toxin A (BTX-A) as a prophylactic treatment in adults with chronic daily headache (CDH). Material and methods: The research participated in 100 patients with CDH comparing two groups of patients. Group I, 54 patients (31 women and 23 men) treated by BTX-A and group II, 46 patients (27 women and 21 men) treated with the classical method, with an average age of 35 ± 9 years. The patient’s condition in group I was assessed on the third day, on the 7th day and the 15th day after the BTX-A injection and assessed every 15 days for 3 months, in group II the patients were evaluated every 15 days. Results: After 3 months headache severity in group I: 2 (3,7%) patients had no changes, 7 (12,9%) patients with less than 50 percent reduction in pain, 23 (42,6%) reported 70 to 95 percent pain relief, and 22 (40,8%) had complete relief. Group II: 12 (26,1%) patients had no changes, 16 (34,8%) patients with less than 50 percent reduction in pain, 10 (21,7%) reported 70 to 95 percent pain relief, and 8 (17,4%) had complete relief. The mean change from baseline frequency of headaches ranged from 3 ± 1 headaches per 30‐day periods in-group I and 7 ± 2 headaches in group II. The patient’s in-group I used painkillers for an acute headache 4 ± 1 day, compared to 10 ± 2 days for the group II per 30-day period. Conclusion: In this study, BTX-A injections are safe, well-tolerated, not any treatment-related serious adverse events reported. BTX-A injections recommended optimizing clinical outcomes for patients with CDH without using other prophylactic medications. Although, further observations are needed.

Highlights

For more than two decades botulinum toxin A (BTX-A) injections have been used in cosmetic treatments to reduce wrinkles
Several patients who were using BTX-A injection for wrinkles reported an improvement in headaches, which they have for several years
A reduction of nociceptive signals from the peripheral nervous system could reduce the central sensitization associated with chronic pain [1,2,3,4]

Summary

Introduction

For more than two decades BTX-A injections have been used in cosmetic treatments to reduce wrinkles. Several patients who were using BTX-A injection for wrinkles reported an improvement in headaches, which they have for several years. This was the beginning of carrying out a multitude of studies to determine the efficacy of BTX-A for headache treatment. Some experimental studies showed that BTX-A could inhibit the release of nociceptive neuropeptides such as substance P from either cholinergic neurons or C or A-delta fibres. This would prevent the local sensitization of nociceptors and, reduce the perception of the pain. A reduction of nociceptive signals from the peripheral nervous system could reduce the central sensitization associated with chronic pain [1,2,3,4]

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Conclusion