Is there a role for botulinum toxin in the treatment of migraine?

Evers, Stefan

doi:10.1007/s11916-003-0078-1

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…There are a number of very enthusiastic anecdotal reports in uncontrolled case series. A recent review by Evers [39] outlines the situation. • Biofeedback has been used as an agent for CDH for many years.…”

Section: Symptomatic Treatment In Chronic Daily Headachementioning

confidence: 99%

Chronic daily headache

Couch

2003

Curr Treat Options Neurol

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The therapy of chronic daily headache (CDH) is complex and involves a combination of drugs, supportive psychotherapy, nondrug therapy, "tender-loving care," and "tough love." CDH is a chronic problem with exacerbations and remissions. Patients with CDH often manifest mood disorders, and recognition and treatment of these problems is a key component of success. The use of preventative antimigraine therapy is a major component of treatment of this condition. Patients with exacerbations may need judicious short courses of medications that can produce medication-overuse headache. Patients may switch to another physician to get opiates or other pain relief medications. The patient may later realize this mistake and return to the physician. Use of patient "contracts," in which the patient agrees not to take more than a prescribed amount of restricted medication or seek it elsewhere, may be helpful. In this area, there is no standard patient or standard therapeutic regimen. The treatment plan must be individualized for each patient. Taking a little extra time to talk with patients and discuss medications, procedures, and goals and objectives may pay bigger dividends in the therapeutic relationship later in the course of treatment.

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Section: Symptomatic Treatment In Chronic Daily Headachementioning

confidence: 99%

Chronic daily headache

Couch

2003

Curr Treat Options Neurol

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The effects of Botulinum Toxin type A on capsaicin-evoked pain, flare, and secondary hyperalgesia in an experimental human model of trigeminal sensitization

Gazerani

Staahl

Drewes

et al. 2006

Pain

143

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The trigeminovascular system is involved in migraine. Efficacy of Botulinum Toxin type A (BoNT-A) in migraine has been investigated in clinical studies but the mechanism of action remains unexplored. It is hypothesized that BoNT-A inhibits peripheral sensitization of nociceptive fibers and indirectly reduces central sensitization. We examined the effect of intramuscular injection of BoNT-A on an experimental human model of trigeminal sensitization induced by intradermal capsaicin injection to the forehead. BoNT-A (BOTOX) or saline was injected intramuscularly in precranial, neck and shoulder muscles to 32 healthy male volunteers in a double blind-randomized manner. Intradermally capsaicin-induced pain, flare and secondary hyperalgesia were obtained before and 1, 4 and 8 weeks after the above treatments. A significant suppressive effect of BoNT-A on pain, flare and hyperalgesia area was observed. The pain intensity area was significantly smaller in BoNT-A group (9.16+/-0.83 cm x s) compared to saline group (15.41+/-0.83cm x s) (P=0.011). The flare area was also reduced significantly in BoNT-A group (29.81+/-0.69 cm2) compared to saline group (39.71+/-0.69 cm2) (P<0.001). Similarly, the mean area of secondary hyperalgesia was significantly smaller in BoNT-A group (4.25+/-0.91 cm2) compared to saline group (7.03+/-0.91 cm2) (P=0.040). Post hoc analysis showed significant differences across the trials with a remarkable suppression effect of BoNT-A on capsaicin-induced sensory and vasomotor reactions as early as week1 (P<0.001). BoNT-A presented suppressive effects on the trigeminal/cervical nociceptive system activated by intradermal injection of capsaicin to the forehead. The effects are suggested to be caused by a local peripheral effect of BoNT-A on cutaneous nociceptors.

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Botulinum toxin and the management of chronic headaches

Evers

2004

Current Opinion in Otolaryngology & Head and Neck Surgery

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Most open studies and case reports suggest an efficacy of botulinum toxin in headache prophylaxis but double-blind, placebo-controlled studies do not confirm this assumption. Larger controlled studies are needed for a definite evaluation of subgroups that might possibly benefit from such a treatment. Migraine, tension-type headache, and cervicogenic headache cannot be regarded as a general indication for a treatment with botulinum toxin.

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Is there a role for botulinum toxin in the treatment of migraine?

Cited by 3 publications

References 30 publications

Chronic daily headache

Chronic daily headache

The effects of Botulinum Toxin type A on capsaicin-evoked pain, flare, and secondary hyperalgesia in an experimental human model of trigeminal sensitization

Botulinum toxin and the management of chronic headaches

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