Back to List
Botulinum Neurotoxin Type A in the
Preventive Treatment of Refractory Headache:
A Review of 100 Consecutive Cases
Tepper SJ, Bigal ME, Sheftell FD, Rapoport AM
Posted: December 2004
Objectives: To review the efficacy of
botulinum neurotoxin type A (BoNT-A) in the preventive treatment
of refractory headache.
Background: Even after receiving expert care, some
patients with refractory headache continue to have high disability
and persistent headaches.
Results: There was a statistically significant
reduction of the frequency of headache days 1 month after BoNT-A
was administered, which was maintained through the 3 months of
study; similarly, a significant reduction in the headache index
and number of severe days with headache per month were found at
1 month and maintained through the 3 months of study. MIDAS
scores were reduced from 34.5 at baseline to 15.9 at 3 months.
A similar pattern was found in those overusing versus nonoverusing
acute medication, though the response was more dramatic in the
Conclusion: BoNT-A may play a role in the preventive
treatment of refractory headache. A significant number of patients
showed decrease in clinically important measurements of their
headaches as well as reduced headache-related disability with this
treatment. Prospective, controlled studies must be considered for
severely disabled, refractory patients.