What is the role of botulinum toxin (BTX) injections for the treatment of secondary headache disorders?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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BTX for the treatment of secondary headache disorders (eg, headache attributed to neck trauma) is usually characterized by pain, which emanates from the neck and shoulders to or through the occipital region of the head. Primary suboccipital pain and other pericranial structures may contribute to both tension and migraine-type headaches.

Hobson and Gladish reported benefit from BTXA treatment of cervicogenic headache from cervical whiplash injuries. [152]

Freund and Schwartz performed a double-blind placebo-controlled study of 26 patients more than 2 years postinjury with more than 6 months of musculoskeletal pain who failed conventional therapy. [126] Injection sites were selected by identifying the 5 most sensitive trigger points by palpation in the cervical region, including the splenius capitis, erectus capitis, semispinalis capitis, and trapezius muscles. Each trigger point site was injected with saline or 100 U of BTX-A.

Of the 26 patients who completed the study, the 14 patients treated with BTX-A showed significantly greater improvement from baseline using a VAS for self-assessing headache pain. They also showed improvement in cervical range of motion. No patient reported unsatisfactory or significant adverse side effects that were greater than expected following prior informed consent. Patients who experienced weakness of the shoulder girdle or neck muscles described it as minimal, acceptable, and consistent with informed consent.

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