Predictors of Response to Botulinum Toxin Type A (BoNTA) in Chronic Daily Headache

Mathew, Ninan T.; Kailasam, Jayasree; Meadors, Lori

doi:10.1111/j.1526-4610.2007.00914.x

Cited by 83 publications

(102 citation statements)

References 34 publications

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“…The type of headache is certainly playing a key role; current findings corroborate the effect on chronic migraine rather than on tensiontype headache [10]. The criterion "chronic" proved to be decisive, meaning patients have headaches more than half of the time.…”

Section: Discussionsupporting

confidence: 63%

“…Most of the open studies related positive results, whilst most of the controlled studies reported negative findings [8,10,12,13]. The type of headache is certainly playing a key role; current findings corroborate the effect on chronic migraine rather than on tensiontype headache [10].…”

Section: Discussionsupporting

confidence: 59%

“…Noteworthy among them is the research done in the field of chronic headache; the results, however, are unfortunately rather contradictory [8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

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Low-dosed Botulinum Toxin A in the Prophylactic Management of Unilateral Migraine: A Randomized Double-blind Placebo-Controlled Crossover Study

Jost¹

2011

TOPAINJ

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Botulinum toxin is a therapeutic option in chronic migraine. No dose-finding studies have been conducted so far. Some authors maintain that one injection into the corrugator muscle will do.Objective: We studied the effect of Botulinum toxin (BTX) injections in patients with strictly unilateral migraine. Methods:We treated 22 patients (ITT) in a crossover design for 4 months with 2 x 5 units Onabotulinum toxin (in the corrugator and occipitalis muscle ipsilaterally). Aside from patient data, we also gathered information on undesired drug effects, besides IQOLA SF36, SF-MPQ SADP, OLBPDQ, VAS (pain intensity and daily living skills), PPI, frequency of attacks and application of medication. The statistical evaluation was guided by SPSS (V.13).Results: Assessed were 19 patients (PP) aged 45.2 ± 11.1 years, thereof 17 women. In both injection intervals there were no clinically relevant and/or statistically significant differences as to the target parameters (for example: VAS pain intensity p=0.702), with a notably evident placebo effect (VAS in placebo prior to the injection was 61.4, after 6 weeks 45.1; good or excellent improvement (TOQ) was quoted by 36.8% after 6 weeks in the placebo group). BTX merely proved superior in two aspects: Regarding the pain quality "throbbing" (SF-MPQ SADP), 11 patients initially indicated a pronounced intensity; after BTX only 4 of them did. As to the severity of the pain felt, (PPI) 42.2 of the subjects described "limiting" or "horrible" pain prior to the injection versus 26.3% six weeks after the injection and 21.1% 4 months later. The placebo group started out with 31.6%, that figure remaining the same (31.6%) 6 weeks later, rising to 42.2% after 4 months. 84.2% of the BTX-group and 63.2% in the placebo group requested a reinjection when the study was completed. Conclusion:The injection of low-dosed Botulinumtoxin A did not show any relevant or significant effects in patients with unilateral migraine without aura. One injection into the corrugator muscle alone must be considered as ineffective. The place-value of the two injection sites remains in the open.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionsupporting

confidence: 59%

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Low-dosed Botulinum Toxin A in the Prophylactic Management of Unilateral Migraine: A Randomized Double-blind Placebo-Controlled Crossover Study

Jost¹

2011

TOPAINJ

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“…Allodynia and scalp tenderness with their chronic daily headache may be a positive indicator for response to BoNTA [3], as may the nature of the pain [4]. Those who have headaches that feel as if there is pressure building from the inside, as if their head was going to explode, are most unlikely to respond to BoNTA, whereas those whose headache pain is more crushing or vice-like or where there is an eye popping sensation have a significantly greater chance for response, whether the headaches be chronic or still episodic in occurrence.…”

Section: Editorial Freitagmentioning

confidence: 99%

Importance of botulinum toxin for prevention of migraine

Freitag

2010

Expert Review of Neurotherapeutics

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“…It decreases the headache frequency, headache intensity, and headache related disability in episodic and chronic migraine patients. In a pilot study [65] to find out the possible predictors of response to botulinum toxin A in the prophylaxis of chronic daily headache. it is seen that chronic migraine patients respond better than chronic tension type of headache, unilateral headache, presence of scalp allodynia, pericranial muscle tenderness appear to be predictors of response to botulinum toxin A in chronic migraine, where as pericranial muscle tenderness may be a predictor of response in chronic type of tension type of headache.…”

Section: Headachementioning

confidence: 99%

Therapeutic Application of Botulinum Toxin in Clinical Practice

Dash¹,

Araf²

2009

TOGMJ

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Botulinum toxin, one of the most potent toxins known, is produced by Clostridium botulinum. It causes a temporary paralysis of muscles by inhibiting vesicular release of acetylcholine in neuromuscular junction and synaptic transmission at cholinergic nerve terminals and causes a temporary paralysis of muscles. Since the approval of botulinum toxin A by FDA for strabismus and blepharospasm in 1989 and botulinum toxin B for cervical dystonia in 2000, its therapeutic uses are expanding. To date, both the serotypes A and B have been used therapeutically. These include various dystonic movement disorders, lacrimal hypersecretion, hyperhydrosis, overactive bladder syndromes both neurogenic and idiopathic, prostatic hyperplasia, various gastrointestinal disorders, headache syndromes like migraine and various spastic disorders. Botulinum toxin does not correct the underlying pathology but only produces clinically symptomatic improvement. The duration of improvement and the percentage of improvement vary between different studies due to differences in doses used; different techniques used for injections and also the dilutions. Still more trials are required to explore newer indications of its use, to find out the exact effective doses, dilutions and techniques, so as to have a prolonged clinical improvement. Though it has a good safety profile, complications are related to chemodenervation of adjacent muscles and injection techniques. This article provides an update on different uses of botulinum toxin in medicine.

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Predictors of Response to Botulinum Toxin Type A (BoNTA) in Chronic Daily Headache

Cited by 83 publications

References 34 publications

Low-dosed Botulinum Toxin A in the Prophylactic Management of Unilateral Migraine: A Randomized Double-blind Placebo-Controlled Crossover Study

Low-dosed Botulinum Toxin A in the Prophylactic Management of Unilateral Migraine: A Randomized Double-blind Placebo-Controlled Crossover Study

Importance of botulinum toxin for prevention of migraine

Therapeutic Application of Botulinum Toxin in Clinical Practice

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