title: Onabotulinum toxin A treatment of cervicogenic headache: a randomised, double-blind, placebo-controlled crossover study.
abstract: OBJECTIVE
  Preliminary reports regarding injections in the neck of onabotulinum toxin A have been positive in cervicogenic headache (CeH). The aim was to perform the first methodologically rigorous trial.
  
  
  METHODS
  A randomised, placebo-controlled, patient-, injector- and evaluator-blinded crossover study included 28 adult patients with a long-standing and treatment-resistant CeH. After a baseline period, injections of either onabotulinum toxin A or placebo were given in fixed sites in the neck muscles on the pain side. Second injections were given after ≥8 weeks. Patients were thereafter followed for another 8 weeks. A detailed headache calendar was filled in, and patients were followed with quality-of-life (QoL) questionnaires, algometry and neck mobility measurements.
  
  
  RESULTS
  There was no significant difference between verum and placebo in a mixed linear model analysis (p = 0.084) with regard to the primary end-point, reduction of days with moderate to severe headache. Six patients withdrew from the study before the second injections, but an intention-to-treat (ITT) analysis gave a similar result (p = 0.27). There were no significant differences favouring verum in any of the secondary efficacy measures. Side-effects of onabotulinum toxin A were minor and short-lasting.
  
  
  CONCLUSIONS
  Onabotulinum toxin A in neck muscles does not seem to be beneficial in CeH.
authors.affiliation: Norwegian University of Science and Technology, Norway. mattias.linde@ntnu.no
authors.forename: Mattias
authors.initials: M
authors.lastname: Linde
authors.forename: Knut
authors.initials: K
authors.lastname: Hagen
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Salvesen
authors.forename: Gøril Bruvik
authors.initials: GB
authors.lastname: Gravdahl
authors.forename: Grethe
authors.initials: G
authors.lastname: Helde
authors.forename: Lars Jacob
authors.initials: LJ
authors.lastname: Stovner
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009334:Neck Muscles / Q000187:drug effects; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D051298:Post-Traumatic Headache / Q000188:drug therapy*; D011788:Quality of Life; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A