title: Treatment of chronic daily headache with comorbid anxiety and depression using botulinum toxin A: a prospective pilot study.
abstract: BACKGROUND
  Psychiatric comorbidities, including depression and anxiety, are clinical entities associated with chronic daily headache (CDH). Botulinum toxin A (BTA) is a Food and Drug Administration approved drug for the treatment of chronic migraine, a subtype form of CDH. This study aimed to investigate the potential efficacy and safety of BTA for controlling psychiatric symptoms in CDH patients.
  
  
  METHODS
  A prospective, open-label, pilot study (n = 30; 7 males, 23 females) was performed. A single low-dose of BTA (40-120 U) was injected into the pericranial muscle at multiple sites. Participants were evaluated before and 1, 4, 8, 12, 16, 20 and 24 weeks after BTA treatment. Primary outcomes included: (1) headache severity, determined by a visual analog scale; (2) depression and anxiety severity, assessed via the Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A, respectively); (3) headache frequency per month and (4) single headache episode duration.
  
  
  RESULTS
  Headache severity was significantly ameliorated one week after treatment. Depression and anxiety symptoms were significantly reduced one month after treatment. At month four, the headache incidence per month decreased from 28.83 ± 2.95 to 17.57 ± 11.30 d (p < 0.001), and the single headache duration decreased from 12.03 ± 9.47 to 6.63 ± 8.98 h (p < 0.001). Furthermore, the percentage of patients who required analgesics significantly decreased. BTA was well tolerated, and the adverse events were mild and transient.
  
  
  CONCLUSIONS
  BTA treatment alleviated the severity and frequency of CDH, with improvements in depression and anxiety. These novel findings indicate that BTA may represent an effective and safe intervention to target psychiatric comorbidities in CDH.
authors.affiliation: a Department of Neurology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China.|b Department of Neurology , The General Hospital of Pingmei Group , Pingdingshan , China.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhang
authors.affiliation: a Department of Neurology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China.
authors.forename: Haifeng
authors.initials: H
authors.lastname: Zhang
authors.affiliation: a Department of Neurology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China.
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Wei
authors.affiliation: a Department of Neurology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China.
authors.forename: Yajun
authors.initials: Y
authors.lastname: Lian
authors.affiliation: a Department of Neurology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: a Department of Neurology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China.
authors.forename: Yake
authors.initials: Y
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D020773:Headache Disorders / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011446:Prospective Studies; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: botulinum toxin A; chronic daily headache; prospective study; psychiatric comorbidity