Poster 122: Botulinum toxin type A injections for the treatment of chronic tension and migraine headaches: a report of 5 cases.

Abstract

Setting: Pain management rehabilitation clinic. Patients: 3 patients with migraine and 2 with chronic tension headache. Case Descriptions: Each patient received botulinum toxin type A (Botox) injections in predetermined sites. A total of 100 to 1200U of Botox was injected over the course of 1 to 4 sessions in an approximate ratio of the muscles bilaterally: obicularis and procerus, 10%; frontalis, 15%; corragator, 5%; temporalis auricularis, 10%; semispinalis, 20%; trapezius and splenius, 20%; and semispinalis capitus, 20%. The percentages were adjusted when actual maximal point tenderness could be determined. Assessment/Results: None of the patients complained of adverse effects from injections and all were assessed using serial physical and neurologic examinations, as well as follow-up by self-reported questionnaires. After completing the injections, 3 expressed an acute feeling of tension relief. All subjects tolerated significant reductions in prescribed medications, and reported an average reduction of 4 points (Wong pain scale) after their first treatment. The 3 subjects who had additional Botox treatments all reported a reduction in headache pain intensity and improvement in daily function. Discussion: The study anticipates a formal Botox versus control study. The effectiveness of the injections was evaluated on the basis of patients tolerating significant reductions in their prescribed pain and muscle-relaxant medications, together with self-reported measures of pain scores and overall function. The absence of side effects at doses of up to 300U per session and up to 4 separate sessions a year demonstrates a safe approach that can be personalized for proper effective treatment. Understanding a standard of administration of Botox is prerequisite for its use as an accepted treatment for chronic headache. Conclusion: This study, with 2-year follow-up and previous findings, demonstrates that Botox may offer a promising, cost-effective, and safe procedure with exceptional efficacy in treating chronic tension headaches as well as migraine headache pain.