Abstract
The objective of this study was to investigate the long-term efficacy and safety of botulinum toxin type-A (BoNT-A) for refractory chronic tension-type headache (CTTH). An open-label, prospective study was carried out in the Department of Neurology of Kirikkale University on 28 patients (8 males, 20 females), mean age 35.6 years, diagnosed with moderate/severe CTTH refractory to preventive medications. Each patient received BoNT-A injections once in pericranial muscles. Efficacy and safety data were analysed for 28 refractory CTTH patients who were receiving concomitant headache prophylactic medications at baseline and during the study. The main outcome parameters were reduction of headache frequency and intensity over 1 year. Both parameters were significantly decreased (p<0.05) by the end of the study. Sixty-four percent of patients reported complete headache relief at the final visit, compared to 7% CTTH persisted. BoNT-A also resulted in significant reductions in analgesic consumption (p<0.05). Adverse effects were transient and local. BoNT-A was found to be an effective and safe treatment for refractory CTTH patients with concomitant headache prophylactic medications, resulting in significant reductions in headache frequency, intensity and analgesic consumption which persisted up to 1 year.
Article PDF
Similar content being viewed by others
References
Mueller L (2002) Tension-type, the forgotten headache. How to recognize this common but undertreated condition. Postgrad Med 111:25–26, 31–32, 37–38, 10.3810/pgm.2002.04.1165, 11985132
Schulman EA (2001) Overview of tension-type headache. Curr Pain Headache Rep 5:454–462, 10.1007/s11916-001-0057-3, 1:STN:280:DC%2BD3Mrht12ltw%3D%3D, 11560811
Cheung RTF (2000) Prevalence of migraine, tension-type headache, and other headaches in Hong Kong. Headache 40:473–479, 10.1046/j.1526-4610.2000.00071.x, 1:STN:280:DC%2BD3cvht1Oruw%3D%3D, 10849044
Gobel H, Petersen-Braun M, Soyka D (1994) The epidemiology of headache in Germany: a nationwide survey of a representative sample on the basis of the headache classification of the International Headache Society. Cephalalgia 14:97–106, 10.1046/j.1468-2982.1994.1402097.x, 1:STN:280:DyaK2czktVOjtg%3D%3D, 8062362
Pryse-Phillips W, Findlay H, Tugwell P et al (1992) A Canadian population survey on the clinical, epidemiologic and societal impact of migraine and tension-type headache. Can J Neurol Sci 19:333–339
Rasmussen BK, Jensen R, Schroll M, Olesen J (1991) Epidemiology of headache in a general population — a prevalence study. J Clin Epidemiol 44:1147–1157, 10.1016/0895-4356(91)90147-2, 1:STN:280:DyaK38%2FksVKlsw%3D%3D, 1941010
Rasmussen BK, Jensen R, Olesen J (1992) Impact of headache on sickness absence and utilisation of medical services: a Danish population study. J Epidemiol Community Health 46:443–446, 10.1136/jech.46.4.443, 1:STN:280:DyaK3s%2Flslamtg%3D%3D, 1431724
Schwartz BJ, Stewart WF, Simon D, Lipton RB (1998) Epidemiology of tension-type headache. JAMA 279:381–383, 10.1001/jama.279.5.381, 1:STN:280:DyaK1c7hvFGlsg%3D%3D, 9459472
Jensen K, Norup M (1992) Experimental pain in human muscle induced by hypertonic saline, potassium and acidity. Cephalalgia 12:101–106, 10.1046/j.1468-2982.1992.1202101.x, 1:STN:280:DyaK383kvVKqsQ%3D%3D, 1576638
Rollnik JD, Karst M, Fink M, Dengler R (2001) Coping strategies in episodic and chronic tension-type headache. Headache 41:297–302, 10.1046/j.1526-4610.2001.111006297.x, 1:STN:280:DC%2BD3M7ms1ehtA%3D%3D, 11264691
Holroyd KA, Stensland M, Lipchik GL et al (2000) Psychosocial correlates and impact of chronic tension-type headaches. Headache 40:3–16, 10.1046/j.1526-4610.2000.00001.x, 1:STN:280:DC%2BD3c3itlemsQ%3D%3D, 10759896
Borodic GE, Acquadro M, Johnson EA (2001) Botulinum toxin therapy for pain and inflammatory disorders: mechanisms and therapeutic effects. Expert Opin Investig Drugs 10:1531–1544, 10.1517/13543784.10.8.1531, 1:CAS:528:DC%2BD3MXmslWht7Y%3D, 11772268
Smuts JA, Baker MK, Smuts HM et al (1999) Prophylactic treatment of chronic tension-type headache using botulinum toxin type A. Eur J Neurol 6(suppl 4):S99–S102, 10.1111/j.1468-1331.1999.tb00044.x
Evers S, Vollmer-Haase J, Schwaag S et al (2004) Botulinum toxin A in the prophylactic treatment of migraine—a randomized, double-blind, placebo-controlled study. Cephalalgia 24:838–843, 10.1111/j.1468-2982.2004.00754.x, 1:STN:280:DC%2BD2cvmslSmsQ%3D%3D, 15377314
Silberstein S, Mathew N, Saper J, Jenkins S, for the BOTOX® Migraine Clinical Research Group (2000) Botulinum toxin type A as a migraine preventive treatment. Headache 40:445–450, 10.1046/j.1526-4610.2000.00066.x, 1:STN:280:DC%2BD3cvht1Ortg%3D%3D, 10849039
Relja MA (1997) Treatment of tension-type headache by local injection of botulinum toxin. Euro J Neurol 4(Suppl 2):71–72
Relja MA (2000) Treatment of tension-type headache with botulinum toxin: 1-year follow-up. Cephalalgia 20:336
Ondo WG, Vuong KD, Derman HS (2004) Botulinum toxin A for chronic daily headache: a randomized, place-bo-controlled, parallel design study. Cephalalgia 2004;24:60–65, 10.1111/j.1468-2982.2004.00641.x, 1:STN:280:DC%2BD2c%2FhslSjtQ%3D%3D, 14687015
Schulte-Mattler WJ, Wieser T, Zierz S (1999) Treatment of tensiontype headache with botulinum toxin: a pilot study. Eur J Med Res 4:183–186
Schmitt WJ, Slowey E, Fravi N et al (2001) Effect of botulinum toxin A injections in the treatment of chronic tension-type headache: a double blind, placebo-controlled trial. Headache 41:658–664, 10.1046/j.1526-4610.2001.041007658.x, 1:STN:280:DC%2BD3MrgsFOisw%3D%3D, 11554953
Rollnik JD, Tanneberger O, Schubert M et al (2000) Treatment of tension-type headache with botulinum toxin A: a double-blind, placebo-controlled study. Headache 2000; 40:300–305, 10.1046/j.1526-4610.2000.00044.x, 1:STN:280:DC%2BD3cvlvVentg%3D%3D, 10759934
Silberstein SD, Göbel H, Jensen R et al (2006) Botulinum toxin type A in the prophylactic treatment of chronic tension-type headache: a multicentre, double-blind, randomized, placebo-controlled, parallel-group study Cephalalgia 26:790–800, 10.1111/j.1468-2982.2006.01114.x, 1:STN:280:DC%2BD28zmtlaquw%3D%3D, 16776693
Burch CM, Kokoska MS, Glaser DA, Hollenbeak CS (2001) Treatment of frontal tension headaches with botulinum toxin A. Cephalalgia 21:486–491, 10.1046/j.1468-2982.2001.00030.x
Relja MA, Telarovic S. Botulinum toxin in tension-type headache (2004) J Neurol 251(Suppl)1/12–1/14
Mennini FS, Fioravanti L, Piasini L et al (2004) A one-year retrospective economic evaluation of botulinum toxin type A treatment of chronic tension headache. J Headache Pain 5:188–191, 10.1007/s10194-004-0099-5
Farinelli I, Coloprisco G, De Filippis S, Martelletti P (2006) Long-term benefits of botulinum toxin type A (BOTOX) in chronic daily headache: a five-year long experience. J Headache Pain 7: 407–412, 10.1007/s10194-006-0344-9, 1:CAS:528:DC%2BD2sXkt1Sjsw%3D%3D, 17149565
Mathew N, Frishberg BM, Gawel M et al (2005) Botulinum toxin type A (BOTOX®) for the prophylactic treatment of chronic daily headache: a randomized, double-blind, placebo-controlled trial. Headache 45:293–307, 10.1111/j.1526-4610.2005.05066.x, 15836565
Jensen R (2003) Peripheral and central mechanisms in tension-type headache: an update. Cephalalgia 23(Suppl. 1): 49–52, 10.1046/j.1468-2982.2003.00574.x, 12699459
Aoki KR (2003) Evidence for antinociceptive activity of botulinum toxin type a in pain management. Headache 43(suppl 1):9–15, 10.1046/j.1526-4610.43.7s.3.x
Cui M, Khanijou S, Rubino J, Aoki KR (2004) Subcutaneous administration of botulinum toxin A reduces formalin-induced pain. Pain 107:125–133, 10.1016/j.pain.2003.10.008, 1:CAS:528:DC%2BD2cXjsFSksA%3D%3D, 14715398
Durham PL, Cady R (2004) Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine therapy. Headache 44:35–42; discussion 42—43, 10.1111/j.1526-4610.2004.04007.x, 14979881
Oshinsky ML, Pozo-Rosich P, Luo J et al (2004) Botulinum toxin type A blocks sensitization of neurons in the trigeminal nucleus candalis. Cephalalgia 24:781
Mathew N (2006) The Prophylactic Treatment of Chronic Daily Headache Headache 46:1552–1564, 10.1111/j.1526-4610.2006.00621.x, 17115988
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Open Access This is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License ( https://creativecommons.org/licenses/by-nc/2.0 ), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
About this article
Cite this article
Kemal Erdemoglu, A., Varlibas, A. The long-term efficacy and safety of botulinum toxin in refractory chronic tension-type headache. J Headache Pain 8, 294–300 (2007). https://doi.org/10.1007/s10194-007-0414-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10194-007-0414-7