What is the efficacy of botulinum toxin A (BTX-A) injections for the treatment of chronic migraine headaches?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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In an open-label study evaluating the effects of BTX-A on patients with episodic and chronic migraine, treatment with 25 U of BTX-A (frontalis, temporalis, and corrugator muscles) demonstrated decreased migraine-associated disability in 58% of patients. [110] Two retrospective studies have emphasized the potential benefit of BTX-A as a "disease modifying" treatment for chronic migraine. [111, 112]

One open-label study involving the use of BTX-B for the treatment of chronic migraine was reported. Forty-seven patients with at least 4 migraine headaches within a 4-week period were treated with a total of 5000 U of BTX-B placed into at least 3 sites. [49] Injection sites were chosen on the basis of pain distribution and included trigger points and glabellar lines. Thirty patients (64%) reported diminished headache intensity and severity. One adverse effect unique to BTX-B versus-A treatment was dry mouth.

Several reports suggest that benefit increases from repeated treatments with BTX-A in patients with chronic migraine. Although not strictly derived from randomized and controlled studies, many injectors consider that these clinical observations are important to consider if the maximal benefit is to be realized from BTX injections. Other retrospective reviews found support for a beneficial role using BTX-A as a prophylactic treatment for migraine. [113, 114, 112, 115, 116] However, these studies were limited by faulty methodology, low numbers of study patients, poorly defined end points, and heterogeneous patient populations, often including other IHS-described types of chronic daily headache. [117]

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