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Prophylactic Treatment of Chronic Tension-Type Headache
Using Botulinum Toxin Type A
Smuts JA, etal.
Posted May 2001
Eur J. Neurology

Chronic tension-type headache is a common condition, the pathophysiology of which is not well understood. Overactivity of the ericranial muscles is thought to play a role, although sustained muscle contraction is probably a consequence, rather than a cause, of headache. Botulinum toxin type A (BTX-A) is useful in many conditions involving excessive muscle contraction and may therefore be effective in relieving the pain associated with this type of headache. To investigate the efficacy of BTX-A in relieving pain associated with chronic tension-type headache, a double-blind, randomized, placebo-controlled study was carried out, in which 37 patients received BTX-A, injected into the temporalis or cervical muscles of the neck. Clinical outcome was measured over a 4-month study period using headache diaries and chronic pain index scores. Patients treated with BTX-A showed an improvement in headache severity over the 4-month study period with 13 out of 22 patients showing a 25, 50 or >50% improvement in headache score at month 3 compared with two out of 15 patients in the placebo group. The number of headache-free days increased significantly in the BTX-A treated patient group, and patients recorded an improvement in quality of life following BTX-A injection. It can be concluded that intramuscular injection of BTX-A is an effective treatment for chronic tension-type headache.