Botulinum toxin and the management of chronic headaches.
OBJECTIVE
There is an increasing number of reports on botulinum toxin in pain therapy, in particular in headache treatment. Therefore, the studies available from reference systems and published congress contributions on the prophylactic treatment of idiopathic and cervicogenic headache with botulinum toxin were analyzed with respect to study design, headache diagnosis, and the significance of results.


RESULTS
For the prophylactic treatment of tension-type headache, migraine, and cervicogenic headache, no sufficient positive evidence for treatment with botulinum toxin is obtained from randomized, double-blind, placebo-controlled trials to date. For the treatment of miscellaneous headache, there is some but no consistent positive evidence.


CONCLUSIONS
Most open studies and case reports suggest an efficacy of botulinum toxin in headache prophylaxis but double-blind, placebo-controlled studies do not confirm this assumption. Larger controlled studies are needed for a definite evaluation of subgroups that might possibly benefit from such a treatment. Migraine, tension-type headache, and cervicogenic headache cannot be regarded as a general indication for a treatment with botulinum toxin.
Evers
Stefan
S
Department of Neurology, University of Münster, Germany. everss@uni-muenster.de
D001905:Botulinum Toxins / Q000008:administration & dosage*; D004311:Double-Blind Method; D020773:Headache Disorders / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007273:Injections, Intramuscular; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D016896:Treatment Outcome
D001905:Botulinum Toxins