Journal of Neural Transmission

, Volume 115, Issue 4, pp 647–651

Evidence based medicine on the use of botulinum toxin for headache disorders


DOI: 10.1007/s00702-007-0832-3

Cite this article as:
Schulte-Mattler, W. & Leinisch, E. J Neural Transm (2008) 115: 647. doi:10.1007/s00702-007-0832-3


Botulinum toxin blocks the release of acetylcholine from motor nerve terminals and other cholinergic synapses. In animal studies botulinum toxin also reduces the release of neuropeptides involved in pain perception. The implications of these observations are not clear. Based on the personal experiences of headache therapists, botulinum toxin injections have been studied in patients with primary headaches, namely tension-type headache (TTH), chronic migraine (CM) and chronic daily headache (CDH). So far, the results of randomized, double-blind, placebo controlled trials on botulinum toxin in a total of 1117 patients with CDH, 1495 patients with CM, and 533 patients with TTH have been published. Botulinum toxin and placebo injections have been equally effective in these studies. In some of the studies, the magnitude of this effect was similar to that of established oral pharmacotherapy. This finding may help to explain the enthusiasm that followed the first open-label use of botulinum toxin in patients with headache. However, research is continuing to determine the efficacy of botulinum toxin in certain subgroups of patients with CM or CDH.

Keywords: Botulinum toxin; headache; pain; evidence based medicine 

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of RegensburgRegensburgGermany

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