title: Ten-year follow-up in a case series of integrative botulinum toxin intervention in adolescents with chronic daily headache and associated muscle pain.
abstract: BACKGROUND
  A total of 83% of children report headache during a 6-month period. The estimated 1-year prevalence of chronic daily headache (CDH) in children is at least 1 to 2%. Muscle pain is associated with headache severity and chronicity. Muscle pain can be associated with active muscular trigger points, a functional concept still remaining a controversy. An integrated approach including bio-behavioral management is accepted as standard treatment but does not provide sufficient pain relief in all patients.
  
  
  OBJECTIVE
  We report the individual clinical course of five adolescents with treatment-refractory CDH associated with focal muscle pain. We describe a concept of short-term integrative intervention including botulinum toxin (StiBo) in a personalized "follow the referred pain pattern" injection regimen with the focus on long-term follow-up.
  
  
  RESULTS
  StiBo showed short-term efficacy on headache frequency and severity. In the long-term follow-up, CDH was not existent in any of the patients.
  
  
  CONCLUSIONS
  The treatment may have enabled the patients to draw attention away from a repeated circle of muscle-triggered pain and withdrawal of daily activities toward self-driven activities, thereby potentially preventing the development of further chronification. To prove this hypothesis, a prospective, placebo-controlled study in young adolescents with CDH should be initiated including objective outcome parameters on muscular level.
authors.affiliation: Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Bavaria, Germany.
authors.forename: A S
authors.initials: AS
authors.lastname: Schroeder
authors.forename: K
authors.initials: K
authors.lastname: Huss
authors.forename: A
authors.initials: A
authors.lastname: Blaschek
authors.forename: I K
authors.initials: IK
authors.lastname: Koerte
authors.forename: B
authors.initials: B
authors.lastname: Zeycan
authors.forename: T
authors.initials: T
authors.lastname: Roser
authors.forename: T
authors.initials: T
authors.lastname: Langhagen
authors.forename: A
authors.initials: A
authors.lastname: Schwerin
authors.forename: S
authors.initials: S
authors.lastname: Berweck
authors.forename: P
authors.initials: P
authors.lastname: Reilich
authors.forename: J
authors.initials: J
authors.lastname: Schaefer
authors.forename: A
authors.initials: A
authors.lastname: Straube
authors.forename: F
authors.initials: F
authors.lastname: Heinen
mesh_terms: D000293:Adolescent; D001905:Botulinum Toxins / Q000627:therapeutic use*; D002648:Child; D005500:Follow-Up Studies; D020773:Headache Disorders / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D059352:Musculoskeletal Pain / Q000150:complications / Q000188:drug therapy*; D010147:Pain Measurement; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001905:Botulinum Toxins