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Predictors of Response to Botulinum Toxin Type A (BoNTA) in Chronic Daily Headache
Ninan T. Mathew, MD; Jayasree Kailasam MD; Lori Meadors PA-C
Posted: May 2008  
Headache  2008;48:194-200

Objective:   To evaluate predictors of response to botulinum toxin type A (BoNTA) in patients with chronic daily headache (CDH).

Background:   Chronic migraine (CM) and chronic tension-type headache (CTTH) form the majority of CDH disorders. Controlled trials indicate that BoNTA is effective in reducing the frequency of headache and number of headache days in patients with CDH disorders. A recent migraine study found that patients with imploding or ocular types of headaches were responders to BoNTA, where as those with exploding headaches were not. To date, there are no data on factors that might predict response to BoNTA in patients with CDH.

Methods:   A total of 71 patients with CM and 11 patients with CTTH were treated with 100 units of BoNTA. Every patient received at least 2 sets of injections at intervals of 12-15 weeks; fixed sites, fixed dose, and “follow-the-pain” approaches were used for the injections. Headache frequency was assessed throughout the study from baseline to weeks 24-27. Patients recorded the frequency, severity, and duration of headaches in headache diaries. Patients were divided into responders and nonresponders.

Conclusions:  A greater percentage of patients with CM responded to BoNTA than patients with CTTH. Headaches that were predominantly unilateral in location, presence of scalp allodynia, and pericranial muscle tenderness appear to be predictors of response to BoNTA in CM, whereas in CTTH, pericranial muscle tenderness may be a predictor of response.