title: Severe, intractable headache after injection with botulinum a exotoxin: report of 5 cases.
abstract: BACKGROUND
  Botulinum A exotoxin is a safe agent in common use in dermatology. Occasionally, patients receiving botulinum toxin injections report postprocedure discomfort, including headaches.
  
  
  OBJECTIVE
  Our purpose was to estimate the rate of severe headaches occurring after injection with botulinum toxin for dermatologic indications.
  
  
  METHODS
  We used prospective monitoring of botulinum toxin injection outcomes in a single-site, 3-dermatologist practice. There was in-office and telephone follow-up of patients experiencing severe headaches.
  
  
  RESULTS
  Approximately 1% of patients (4/320) receiving botulinum A exotoxin injections may experience severe, debilitating headaches. These may persist at high intensity for 2 weeks to 1 month before gradually fading.
  
  
  CONCLUSIONS
  Botulinum A exotoxin injection may be associated with the development of life-altering headaches. Patients should be informed of this possibility.
authors.affiliation: DermSurgery Associates, Houston, Texas, USA. murad@alam.com
authors.forename: Murad
authors.initials: M
authors.lastname: Alam
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Arndt
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Dover
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects*; D005145:Face; D005260:Female; D006261:Headache / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D015361:Rhytidoplasty; D012720:Severity of Illness Index; D015595:Skin Aging
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A