Botulinum Toxin Type A for the Treatment of Nummular Headache: Four Case Studies

Abstract

BoNTA appears to be a well-tolerated effective treatment for intractable, persistent nummular headache in patients with an inadequate response to other treatments including NSAIDs, gabapentin, or local anesthetics.

Nummular headache associated with focal hair heterochromia in a child

“…Infiltration of local anaesthetic has not ameliorated the pain with primary NH, but no reports describe this approach in patients with co-localised ectodermal lesions (13). Botulinum toxin type A has had moderate success (14).…”

Nummular headache: Six new cases and lancinating pain attacks as possible manifestation

“…In our sample, treatment with amitriptyline or duloxetine was unsuccessful in two patients. New treatment options include local botulinum toxin that was successful in 7/9 cases in the literature (18,19) and one of our cases, and local transcutaneous electric nerve stimulation (one case) (20). It is not known if the pressing-continuous type of nummular headache requires different treatment from the paroxysmallancinating type, although under the assumption of neuropathic pain and led by the symptomatology, one might prefer gabapentin or pregabalin and antidepressants for chronic-continuous pain and oxcarbazepine and antidepressants for paroxysmallancinating pain (21).…”

Botulinumtoxin A in der Kopfschmerztherapie

“…Neurologische Auffälligkeiten sowie auch pathologische Befunde in der Bildgebungen bestehen nicht. Wiederholt wurde von einer erfolgreichen Behandlung durch die lokale subkutane Injektion kleiner Mengen Botulinumtoxin A berichtet [28,30]. Alternativ wurden auch Gabapentin bzw.…”