Botulinum Toxin Type A as a Migraine Preventive Treatment

Silberstein, Stephen D.; Mathew, Ninan T.; Saper, Joel R.; Jenkins, Stephen

doi:10.1046/j.1526-4610.2000.00066.x

Cited by 486 publications

(303 citation statements)

References 9 publications

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“…A peripheral antinociceptive effect of the neurotoxin has been suspected on the basis of the reduction in pain associated with migraine headaches, spasmodic torticollis, and chronic myofascial pain [10][11][12]. Welch et al observed that various botulinum toxins inhibited release of neuropeptides from rat dorsal root ganglia [13], and Jabbari et al reported that multiple subcutaneous BTX-A injections relieved segmental burning pain [14].…”

Section: Discussionmentioning

confidence: 99%

Botulinum a Toxin Intravesical Injections in the Treatment of Painful Bladder Syndrome: A Pilot Study

Giannantoni¹,

Costantini²,

Stasi³

et al. 2006

European Urology Supplements

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e u r o p e a n u r o l o g y 4 9 ( 2 0 0 6 ) 7 0 4 -7 0 9 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Article info AbstractObjective: We evaluated the efficacy and tolerability of botulinum A toxin (BTX-A) intravesical injections in patients affected by painful bladder syndrome with increased urinary frequency, refractory to conventional treatment modalities. Methods: Twelve women and two men were prospectively included in the study. Under short general anaesthesia patients were given injections of 200 U of commercially available BTX-A diluted in 20 ml 0.9% NaCl. Injections were performed submucosally in the trigone and bladder floor under cystoscopic control. Voiding chart, the Visual Analog Scale (VAS) for pain, and urodynamics were performed before treatment and 1 and 3 mo afterward. Results: Overall, 12 patients (85.7%) reported subjective improvement at 1 and 3 mo follow-up. The mean VAS score was significantly reduced at 1 and 3 mo after treatment ( p < 0.05 for both); at the same time points daytime and nighttime urinary frequency significantly decreased ( p < 0.01 and p < 0.05, respectively), and bladder cystometric capacity significantly increased ( p < 0.01). Two patients reported incomplete bladder emptying. We did not detect any systemic side effects during or after treatment. Conclusions:The results of this pilot study indicate that BTX-A intravesical injections are effective in the short-term management of painful bladder syndrome. By modulating afferent C-fiber activity within the bladder walls, BTX-A significantly improves urodynamic parameters and reduces bladder pain and urinary frequency. #

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Section: Discussionmentioning

confidence: 99%

Botulinum a Toxin Intravesical Injections in the Treatment of Painful Bladder Syndrome: A Pilot Study

Giannantoni¹,

Costantini²,

Stasi³

et al. 2006

European Urology Supplements

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“…It has also been reported to be effective in the therapy for migraine [4,5] or chronic migraine [6][7][8]. On analogy to migraine, during CH attacks an activation of the trigemino-vascular system and an elevation of calcitonin gene-related peptide (CGRP) in the jugular venous blood [9] have been observed.…”

Section: Introductionmentioning

confidence: 99%

Botulinum toxin type-A therapy in cluster headache: an open study

et al. 2007

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The objective of this open single-centre study was to evaluate the efficacy and tolerability of botulinum toxin type-A (BTX-A) as add-on in the prophylactic treatment of cluster headache (CH). Twelve male patients with episodic (n=3) or chronic (n=9) CH, unresponsive to common prophylactic medications, were treated with a cumulative dose of 50 International Units (IU) BTX-A according to a standardised injection scheme into the ipsilateral pericranial muscles. One patient with chronic CH experienced a total cessation of attacks and in 2 patients attack intensity and frequency improved. In another patient with chronic CH typical attacks were not influenced, but an ipsilateral continuous occipital headache significantly improved. Patients with episodic CH did not benefit from BTX-A treatment. Tolerability was excellent. These findings provide evidence that BTX-A may be beneficial as an add-on prophylactic therapy for a limited number of patients with chronic CH.

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“…Thereafter, patients were injected with 75-100 U BoNT-A (Botox; Allergan, Irvine, USA) at the referred pain sites. We followed the dosing guide per single muscles as suggested by basic Siberstein [8] and the protocol "fixed sites fixed doses" (FSFD) with a maximun BoNT-A dosage of 100 U per session. BoNT-A was reconstituted and diluted in sterile saline at a concentration of 100 U/ml.…”

Section: Methodsmentioning

confidence: 99%

“…Botulinum toxin type A (BoNT-A) is a focally acting neurotransmitter from presynaptic nerve endings at the neuromuscular junction that results in muscle relaxation. Treatment with BoNT-A is a safe and efficacious treatment of CTH and migraine [6][7][8]. Although its mechanism of action in headache disorders is unknown, BoNT-A may have antinociceptive effects apart from its muscle-relaxing actions [9].…”

Section: Introductionmentioning

confidence: 99%

Reduction in expenditures on analgesics during one year of treatment of chronic tension headache with BoNT-A

et al. 2003

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The aim of this study was to investigate the impact of the use of botulinum toxin type A (BoNT-A; BOTOX; Allergan, Inc.; Irvine, CA) as preventive treatment of chronic tension-type headache (CTH) on analgesic use and expenditure. This was a prospective, single-center, 1-year, open-label study of the effect of BoNT-A treatment on acute analgesic use and expenditure in CTH patients. A structured headache questionnaire, which included questions about medication costs, was completed by CTH patients attending a specialist headache clinic in Rome prior to BoNT-A injections. Repeat injections were administered every 3 months for up to 1 year. Patients were required to complete the questionnaire prior to each injections cycle. A pharmacoeconomic analysis was performed at each assessment to determine the effect of BoNT-A treatment on analgesic use and expenditure. Three hundred questionnaire were distributed and 296 (98%) were completed. The study population consisted of 67.8% (201) females and 32.2% (95) males, with a mean age of 46.7±16.1 years. The economic evaluation of the pharmacologic treatment of CTTH was conducted on the 101 (34.12%) patients who gave complete information on posology. Pharmacoeconomic data analysis focused on the whole group using analgesics compared to those who self-prescribed and those who turned to health specialists before and after treatment with BoNT-A. Prior to treatment with BoNT-A the median monthly pharmaceutic expenditure per patient was euro (€) 24.30 for the whole group using analgesics, and € 34.93 and € 18.51 for the "self-prescribers" and the "prescribed by specialist" groups, respectively. Median monthly pharmaceutic expenditure decreased significantly for the whole group (p<0.001), the "self-prescribers" (p<0.01), and the "prescribed by specialist" group (p<0.002) (3rd month: € 13.3, 9.3, 7.2, respectively; 6th month: € 8.9, 9.0, 4.1, respectively; 9th month: € 5.7, 12.4, 3.0, respectively; 12th month € 4.1, 9.8, 3.4, respectively). BoNT-A treatment produced significant reductions in both analgesic use and expenditure. The data suggest that consultation with a specialist would be helpful in patients with CTTH. Cooperative studies on cost analysis of chronic daily headaches, including both CTTH and chronic migraine, comparing the economic cost package borne by patient and community both before and after treatment with BoNT-A, are warranted. However, in the near future additional studies to compare clinical efficacy of BoNT-A in CTTH with its painkiller use/expenditure in the control of pain are needed in order to avoid any possible interference due to placebo effect.

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Botulinum Toxin Type A as a Migraine Preventive Treatment

Cited by 486 publications

References 9 publications

Botulinum a Toxin Intravesical Injections in the Treatment of Painful Bladder Syndrome: A Pilot Study

Botulinum a Toxin Intravesical Injections in the Treatment of Painful Bladder Syndrome: A Pilot Study

Botulinum toxin type-A therapy in cluster headache: an open study

Reduction in expenditures on analgesics during one year of treatment of chronic tension headache with BoNT-A

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