Evidence-based medicine: botulinum toxin A in migraine and tension-type headache.
The therapeutic effect of botulinum toxin in headache was observed coincidentally. The rationale for this new indication initially met with a great deal of scepticism, because the toxin's mechanism of action, cholinergic chemodenervation, does not fit the pathophysiological concept of migraine and other forms of headache. Meanwhile a fair number of studies have been published which indicate efficacy for botulinum toxin and recommend its use for the treatment of tension headache and migraine. According to the evidence-based medicine criteria, grade I evidence has been demonstrated. In addition the use of botulinum toxin for cluster-headache and secondary headache is discussed. Further large scale studies will be regarded to demonstrate the long-term efficacy.
Göbel
H
H
Kiel Pain Clinic, Heikendorfer Weg 9-27 D-24149 Kiel, Germany.
Heinze
A
A
Heinze-Kuhn
K
K
Jost
W H
WH
D000818:Animals; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D018781:Tension-Type Headache / Q000188:drug therapy*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A