What are the indications for BOTOX® botulinum toxin (BTX) for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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In October 2010, BOTOX® was approved for the prophylaxis of headaches in adult patients with chronic migraine, defined as headaches occurring 15 or more days per month with the duration of untreated headaches lasting 4 hours or more per day. A differential diagnosis was considered as including chronic tension type headaches, new daily persistent headache, and hemicrania continua. [161]

BTX is an appropriate consideration for treatment of refractory headache, especially chronic daily headache, and when standard oral pharmacology is ineffective or fraught by adverse side effects. The transformation of migraine and tension-type headache to chronic daily headache may result from peripheral and central sensitization involving vascular and muscular tissues innervated by trigeminal and pericranial (including upper cervical) nerves.

Also, BTX prophylaxis is an enticing alternative to many standard preventive medications that interfere with alertness or cognitive efficiency in people who provide complex intellectual services or operate industrial equipment, including aircraft or other vehicular machinery. Therapeutic benefits may occur due to elimination of localized myalgia, muscular triggers, or painful muscle tension that accompany a headache; however, theorized BTX CNS antinociceptive effects may prove to be more salient.

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