What is the efficacy of botulinum toxin (BTX) injections for the treatment of cervicogenic headache?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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A single-center, randomized, double-blind, active placebo-controlled trial of neck pain treatment for cervicogenic headache failed to show any significant differences between patients receiving physical therapy following a local anesthetic injection versus BTX-A into symptomatic trigger points. [153] However, faulty methodology and documentation was evidenced due to the authors' failure to outline the number of subjects, medication dosages, or number of sites injected. Furthermore, outcome measures were nonspecific and subjective. The information supplied in the abstract does not support any conclusion regarding the use of BTX-A for neck pain or headache.

Patients with cervical dystonia frequently report pain. Multiple studies have demonstrated that BTX is clinically effective in reducing painful muscle spasm and the abnormal head posture of cervical dystonia, as well as eliciting a dramatic reduction in the degree of pain, which is appreciated throughout the duration of the neurotoxin's expected effect.

BTX-A has also been demonstrated to reduce the pain that results from muscle spasticity. More recently BTX has been applied to treat more common painful disorders such as headache, neck pain, and back pain. The beneficial effect attributed to BTX is thought to be due to its capacity to reduce painful muscle contracture or spasm; therefore, research is underway to determine whether it can be used effectively as an intervention for MPS, which has been studied extensively throughout the literature but remains controversial and poorly understood.

Headache due to craniocervical dystonia is cited as an accepted cause of headache in the 2004 ICHD. A retrospective data analysis looked at 70 patients with craniocervical dystonia or facial (blepharospasm or oromandibular) dystonia who were treated for headaches with BTX-A. [154] Headaches with craniocervical dystonia were usually localized to the occipital (61%) or upper cervical (71%) regions. BTX-A treatment of dystonic muscles resulted in reduced craniofacial pain (eg, headache) in as many as 75% of patients. Reported adverse events were mild.

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