title: Treatment of chronic cervical-associated headache with botulinum toxin A: a pilot study.
abstract: OBJECTIVE
  To see whether therapy with botulinum toxin A may prove to be an effective treatment for headache of musculoskeletal origin.
  
  
  BACKGROUND
  Headache is a common finding associated with neck injury. Cervicogenic headache, which is believed to be attributable to injury of the ligaments, muscles, or joints of the cervical spine, is centered in the occipital region with pain referred to the frontotemporal region. Botulinum toxin A produces prolonged muscle relaxation, which is dose dependent and can be easily targeted to affected muscles.
  
  
  METHODS
  This randomized, double-blind, placebo-controlled study compares outcome measures in 26 patients suffering from chronic headache subsequent to a cervical whiplash injury. One half of the patients received botulinum toxin A, 100 units, diluted in 1 mL of saline, while the other half received just saline (1 mL). Five cervical trigger points received 0.2 mL each of injectant via a 30-gauge needle. Outcome measures included subjective head pain based on visual analog scales, as well as range of neck motion. Follow-up assessments were carried out at 2 and 4 weeks after treatment.
  
  
  RESULTS
  Fourteen subjects who received botulinum toxin A and 12 who received saline completed the study. At both 2 and 4 weeks post injection, the treatment group showed a significant improvement in pain and range of motion from preinjection levels (P<.01). The placebo group demonstrated no statistically significant changes at any posttreatment time.
authors.affiliation: Crown Institute and University of Toronto, Faculty of Dentistry.
authors.forename: B J
authors.initials: BJ
authors.lastname: Freund
authors.forename: M
authors.initials: M
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D006261:Headache / Q000188:drug therapy* / Q000503:physiopathology; D020773:Headache Disorders / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010147:Pain Measurement; D010865:Pilot Projects; D016059:Range of Motion, Articular
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A